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Authorization Specialist- RN/LPN/ Medical Experience
4 months ago
Job Description
Recertification Authorization Specialist
Job Description
The Recert Authorization Specialist is responsible for recertification of home health benefits and ensuring quality patient care via development and evaluation of individual patient care plans in the home setting. The Recert Authorization Specialist ensures continuity of client care and assists other team members with care oversite. The Recert Authorization Specialist serves as the liaison between the Agency and the Department of Labor, which oversees disbursement of DEEOICP benefits. They are responsible for safeguarding client benefits through advocation, management, coordination, and supervision of the related clinical records and activities utilizing professional standards of care and Agency Policies & Procedures. The Recert Authorization Specialist reports directly to the Assistant Authorizations Manager, Authorizations Manager, and Operations Manager utilizing and adhering to the chain-of-command. The Recert Authorization Specialists are a vital component of the care team. They must always support and maintain a positive work environment through a personal commitment to the Company's vision and values while demonstrating and maintaining strong leadership skills.
Essential Functions:
* Provides oversight of care documentation within the Agency's database by the nursing skilled team with attention to quality patient care and patient family satisfaction.
* Coordinates care recertification requirements with Case Managers and the field team and assists in ensuring ease of care transitions.
* Ensures proper implementation, evaluation, and oversight of all assigned clients and their Plan of Care with field staff.
* Works with management team to ensure that program regulatory compliance and care standards are maintained.
* Maintains knowledge of all relevant chapters in the EEOICP Manual and program updates and provides education to field staff when needed to safeguard or advocate for client benefits.
* Performs Quality Assurance Audits of Case Managements care documentation within the Agency's database and assists the ADON(s) with ensuring follow-through.
* Maintains an ongoing complete DOL Benefits Analysis for the assigned client(s)
* Builds rapport and communicates effectively with ADON(s), Case Managers, and applicable skilled nursing staff.
* Works alongside Managers to manage time effectively and schedule work load for maximum efficiency as needed and remains detail oriented to deadlines and cost efficiency.
* Maintains communication within the authorization team, including a weekly update with the Authorizations Manager, DON/Clinical Manager, and Operations Manager.
* Coordinate with Quality Assurance staff in documentation development as needed to maintain documentation compliance.
* Demonstrates positive attitude, exhibits appropriate behaviors, and takes accountability as expected to maintain and promote a cohesive work environment.
* Participates in monthly Case Management/Care Plan meetings and displays appropriate knowledge of assigned clients.
* Maintains professionalism and exhibits behavior appropriate for the position.
* Participates in required Company in-service/education programs as scheduled.
* Participates in designated company committees per direction/instruction.
* Abides by and promotes all Agency Policies & Procedures.
* Demonstrates effective delegation of tasks, working with and through others as needed as directed by Authorizations Managment.
* Maintains a continuing knowledge of competencies related to the Nursing/healthcare profession by participating in formal education programs, conference, workshops, and professional organizations, as applicable.
* Participates in management and leadership team discussions when directed to identify and attend to the need for reassignment of responsibilities per company development and growth.
* Treats co-workers, management, company clients, physicians, and DOL MBE's with absolute customer service and professionalism.
* Available and present during assigned company office hours (unless pre-arranged with Manager) to enable accessibility for staff and colleagues.
* Maintains up-to-date notes regarding client recertification within the Agency's database.
* Assists physicians with sample documentation.
* Assists physicians and clients with prior authorizations for medications, DME, and home modifications as needed.
* Participates in performance reviews and goal setting as directed for professional growth.
* Acquires and provides to the team the detailed information regarding an assigned client to establish the foundation for treatment Plan of Care and to ensure the accuracy of the medical record.
* Participates in public relations and community activities that promote RAH's role as an effective provider of in-home care in the DOL OWCP's programs, as needed.
* Observes the structure and chain of command of the Agency (per Organizational Chart)
* The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this position. The incumbents may be requested to perform job related tasks other than those stated in this description.
Education, Training, and Skill Recommendations/Requirements:
* Current RN or LPN licensure in state(s) deemed necessary by the Company or a healthcare related degree deemed equivalent by Authorizations Manager
* Minimum 3 years progressively responsible clinical experience
* Excellent writing, organizational, and time management skills
* Prior management or leadership experience necessary
* Ability to work independently, multi-task, prioritize, and function in a team environment
* Must possess a professional, courteous, compassionate and customer-oriented demeanor
* Must be discrete, trustworthy, and possess a high level of integrity
* Excellent computer and internet skills.
Note: This job description is not intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with this job.
Upon hire and throughout the term of your employment, you are required to provide full disclosure and explain any violations that have been reported to the State Board of Nursing or Certifying Agency.
I have read my job description and understand my responsibilities.
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Authorization Specialist Signature Date
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Director Signature Date
Company Description
Remain At Home offers the very best in personalized home health care for nuclear energy workers. The company is rapidly expanding all over the United States.
Remain At Home offers the very best in personalized home health care for nuclear energy workers. The company is rapidly expanding all over the United States.
