RN Authorizing Specialist

Description

Salary: $78,000 per year or more depending on experience

Location: Las Vegas, NV

Full-Time, Monday-Friday

Here's Why Our Team Likes Working with Us:·

• Benefits eligible at 30 hours per week.
• Medical, dental, vision, and 401K
• Supplemental insurance available.
• Unlimited Paid Time Off (PTO)
• Matching 401k

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 authorization specialist will also use their clinical knowledge and experience to promote quality patient care. Additionally, the RN Authorization Specialist will prepare documentation, perform audits of patient records, 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:

• 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 reauthorization of patients.
• Maintains a 100% monthly average of controllable submissions to DOL prior to the patient’s expiration date.
• Maintains a 100% monthly average of completing and submitting a 60-day summary to the ordering physician.
• 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 episodes in the electronic medical record during the renewal period.
• 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.
• Keeps the renewal pipeline current with any changes daily.
• Establish and promote a collaborative relationship with patient, physicians, payers, and other members of the health-care team.
• Collects and communicates pertinent, timely information to payers to ensure reauthorization of patient’s home health care services.
• Collaborates with the patient, State Administrators and other clinical staff to coordinate patient authorization periods.
• Coordinates with the patient, State Administrators and other clinical staff regarding scheduling and attending patient renewal appointments, and regarding episodes in the electronic medical record.
• Schedules or support in scheduling all renewal appointments in assigned region.
• Actively involved in the process 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

Related Competencies

Language Skills:

Must be able to read, analyze, and interpret general business practices, policies and procedures, professional journals, technical guidelines, and governmental regulations. Must be able to write reports, business correspondence, and procedure

manuals. Must be able to effectively present information and respond to questions from groups of managers, clients, customers, and the public. Must be able to provide guidance and direction accurately and clearly to Company staff and employees.

Business Acumen:

Through the use of related law and industry data, proactively identify Company risks and institute policies and/or procedures to ensure compliance.

Decision Making:

Identify and understand issues, problems, and opportunities; possess ability to analyze data from different sources to draw conclusions; utilize effective approaches for choosing a course of action or developing appropriate solutions; take action that is consistent with available facts, constraints, and probable consequences.

Other Requirements:

Maintain current state licensure. Maintain current liability and malpractice insurance, if applicable.

Education/Training

• Graduate from an accredited school of nursing.
• Current Registered Nurse license to practice professional nursing in the State in which the employee resides

Licensure/Certification

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

Clearances

The following background checks are conducted:

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

#TFIND

Salary : $78,000