RN Authorizing Specialist - Home Healthcare

CNSCares•Las Vegas, NV

1d•$80,000•Hybrid

About The Position

The RN Authorizing Specialist provides timely review of authorization requests to ensure they meet applicable standards, regulatory requirements, and contractual requirements. The role uses clinical knowledge and experience to promote quality patient care. It also involves preparing documentation, auditing patient records, and coordinating with the clinical team as needed. This is a full-time, Monday-Friday role with a hybrid work schedule in Las Vegas, Nevada. Salary is $80,000 per year or more, depending on experience. The position requires regular attendance and punctuality, the ability to work with people at all levels of the Company, exceptional customer service, and comprehensive in-home clinical knowledge.

Requirements

Graduate of an accredited school of nursing.
Current Registered Nurse compact license.
At least two years of home health experience.
Valid driver's license.
Valid and current BLS certification.

Nice To Haves

Home health RN authorization experience is strongly preferred.
Home health Department of Labor (DOL)/EEOICPA experience is strongly preferred.

Responsibilities

Evaluate the medical necessity and appropriateness of ordered levels of care using standard criteria and clinical judgment to optimize patient outcomes.
Provide accurate, complete documentation and rationale to support patient reauthorization.
Maintain a 100% monthly average of controllable submissions to DOL before the patient's expiration date.
Complete and submit a 60-day summary to the ordering physician, maintaining a 100% monthly average.
Complete assigned chart reviews within established time frames.
Create plans of care in accordance with state and accrediting body regulations and maintain a 100% monthly average of controllable up-to-date plans of care.
Create episodes in the electronic medical record during the renewal period.
Update the electronic medical record with authorizations within 24 hours of notification.
Request continuation of care when appropriate and enter continuation-of-care information into the electronic medical record.
Keep the renewal pipeline current with changes each day.
Build and promote collaborative relationships with patients, physicians, payers, and other health-care team members.
Collect and communicate timely, pertinent information to payers to support reauthorization of patients' home health care services.
Collaborate with patients, State Administrators, and other clinical staff to coordinate patient authorization periods.
Coordinate with patients, State Administrators, and other clinical staff on scheduling and attending patient renewal appointments and on electronic medical record episodes.
Schedule or support scheduling of all renewal appointments in the assigned region.
Participate in process-improvement activities to achieve optimal clinical, financial, operational, and satisfaction outcomes.
Participate in assigned quality assurance committees and interdepartmental projects as needed or requested.
Maintain current knowledge of payer policies and procedures.
Perform other duties as assigned.