RN Authorizing Specialist - Home Healthcare

CNSCares•Oak Ridge, TN

1d•Hybrid

About The Position

On behalf of CNS Cares, the RN Authorizing Specialist reviews authorization requests promptly and ensures they meet applicable standards, regulatory requirements, and contractual requirements. The specialist uses clinical knowledge and experience to promote quality patient care, prepares documentation, audits patient records, and coordinates with the clinical team as needed. This role evaluates the medical necessity and appropriateness of ordered levels of care using standard criteria and clinical judgment. It documents rationale to support reauthorization, coordinates renewal appointments and authorization periods, and maintains accurate patient information and plans of care in the electronic medical record. The specialist also collaborates with patients, physicians, payers, State Administrators, and other healthcare team members, and participates in quality assurance and process improvement activities. The position is based in Knoxville, Tennessee, with a hybrid work schedule. It is full-time, Monday through Friday, and pays $80,000 per year or more depending on experience.

Requirements

Graduate from 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.
Complete criminal background, driving record, OIG Exclusion List, and Sex Offender Registry checks.

Nice To Haves

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

Responsibilities

Evaluate the medical necessity and appropriateness of ordered levels of care using standard criteria and clinical judgment.
Provide accurate and complete documentation with rationale to support patient reauthorization.
Maintain a 100% monthly average of controllable submissions to the Department of Labor before patient expiration dates.
Maintain a 100% monthly average of completing and submitting 60-day summaries to ordering physicians.
Complete assigned chart reviews within established time frames.
Create plans of care according to 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 renewal periods.
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 daily changes.
Establish and promote collaborative relationships with patients, physicians, payers, and other healthcare team members.
Collect and communicate pertinent, timely information to payers to support reauthorization of home health services.
Collaborate with patients, State Administrators, and clinical staff to coordinate patient authorization periods.
Coordinate with patients, State Administrators, and clinical staff regarding renewal appointment scheduling and attendance, and electronic medical record episodes.
Schedule or support the 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 when needed or requested.
Maintain current knowledge of payer policies and procedures.
Maintain regular attendance and punctuality, work effectively with people at all levels of the company, provide exceptional customer service, and demonstrate comprehensive in-home clinical knowledge.
Perform other duties as assigned.