RN Authorizing Specialist - Home Healthcare

Description

Salary: $80,000 per year or more depending on experience

Location: Knoxville, TN

Hybrid Work Schedule

Full-Time, Monday-Friday

Benefits Summary

• Medical, dental, vision, and 401K
• Matching 401k (up to 6% match)
• Unlimited Paid Time Off (PTO)
• Health Savings Account (HSA)

Position Summary 

On behalf of CNS Cares (“CNS” or “Company”), the purpose of this position is to provide timely review of authorization requests and ensure the requests meet all applicable standards, regulatory, and contractual requirements. The RN Authorizing Specialist will also use their clinical knowledge and experience to promote quality patient care. Additionally, the RN Authorizing Specialist will prepare documentation, perform audits of patient records, and coordinate with the clinical team as needed. 

Essential Functions 

Employee must have regular attendance/punctuality, be able to work with others at all levels of the Company, have exceptional customer service, and demonstrate a comprehensive in-home clinical knowledge base. Other assigned duties include: 

• Collaborates with the sales team on all new incoming leads in preparation for start of care appointments.  
• Evaluates the medical necessity and appropriateness of ordered level of care, utilizing standard criteria and clinical judgment to optimize patient outcomes. 
• Provides accurate and complete documentation with rationale to ensure authorization of patients. 
• Obtains and reviews medical records, diagnostics, impairment ratings and other supportive forms. 
• Maintains a 100% monthly average of controllable submissions to DOL prior to the patient’s expiration date. 
• Completes assigned chart reviews as assigned within established time frames. 
• Creates plans of care according to state and accrediting body regulations and maintains a 100% monthly average of controllable up to date plans of care. 
• Creates care periods in the electronic medical record during the start of care/renewal period. 
• Maintains documentation in the EMR and CRM as assigned. 
• Updates the electronic medical record with authorizations within 24 hours of notification of authorization. 
• Requests continuation of care when appropriate and enters continuation of care information into the electronic medical record. 
• Tracks the authorization pipeline and notifies the team of upcoming authorization expirations. 
• Establish and promote a collaborative relationship with patients, physicians, payers, and other members of the healthcare team. 
• Collects and communicates pertinent, timely information to payers to ensure reauthorization of patient home health care services. 
• Collaborates with the local team, clinical /non-clinical staff, and patient to coordinate patient authorization periods. 
• Coordinates with the local team, clinical/non-clinical staff and patients regarding scheduling and attending patient renewal appointments, and regarding episodes in the electronic medical record. 
• Attend weekly meetings to discuss leads, renewal patients and patients at risk. 
• Professionally and effectively communicate with outside facilities as needed to coordinate services. 
• Schedules or support in scheduling all renewal appointments in assigned region. 
• Actively involved in the process of improvement activities to achieve the optimal clinical, financial, operational, and satisfaction outcomes. 
• Participates in assigned quality assurance committee(s) and interdepartmental projects when needed or requested. 
• Demonstrates current knowledge of Payor policy and procedure(s). 
• Other duties as assigned. 

Requirements

Education/Training
Required:

• Graduate from an accredited school of nursing.
• Current Registered Nurse compact license
• At least two (2) years of home health experience

Preferred:

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

Licensure/Certification

• Valid Driver’s License
• Valid and current BLS Certification
• Valid Registered Nurse (RN) compact license

Clearances

The following background checks are conducted:

• Criminal background
• Driving Record
• OIG Exclusion List
• Sex Offender Registry

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