RN Authorizing Specialist

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

Location: Albuquerque, NM

*This position is fully remote, but must live in the state of New Mexico

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)

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:

• 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.

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

#TFIND