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Intake and Authorization Nurse

2 months ago

Colorado Springs, Colorado, United States Innovive Health Full time
About the Role

We are seeking a highly skilled and experienced Intake and Authorization Nurse to join our team at Innovive Health. As a key member of our clinical operations team, you will play a critical role in ensuring the smooth and efficient intake and authorization process for our patients.

Key Responsibilities
  • Coordinate new referrals, resumptions of care, and re-admissions for home health services.
  • Promote and ensure adherence to high levels of communication between referral sources and internal stakeholders.
  • Ensure timely notification to referral sources regarding status.
  • Obtain all necessary documents, including patient medical history, immunizations, medication lists, and face-to-face documentation.
  • Review incoming paperwork for compliance with state, federal, and payor regulations.
  • Enter and upload documentation into our electronic medical record (EMR) system.
  • Run eligibility for new referrals and coordinate issues with the Senior Clinical Documentation Specialist.
  • Enter new providers into the system via the MD Request line in HealthWyse and Salesforce.
  • Confirm PECOS and Medicaid program registration of new providers at time of referral.
  • Reconcile new providers that require supervision per regulatory standards to their supervising physician in EMR.
  • Run the Physician PECOS list once a week.
  • Collect demographic information, check insurance eligibility, and collect required documentation to ensure regulatory compliance with Medicare and Medicaid.
  • Obtain prior authorization or pre-certification of home health services as required by each individual payor and single access point in Colorado.
  • Serve as an internal resource and consultant to Clinical and Authorization Department staff on medical necessity documentation, reimbursement, clinical resource utilization, and care coordination issues.
  • Assist the authorization department staff with clinical-related questions and formulate appropriate responses to HealthFirst designated PAR entities.
  • Review assigned denied decisions and report to Clinical Director and VP of Strategy with recommendations for future process improvements.
  • Adhere to HIPAA laws and maintain patient confidentiality at all times.
  • Participate in continuing education, committees, and meetings as required.
Requirements
  • Graduate of an accredited school of nursing with a Bachelor of Science in Nursing.
  • Currently licensed as an RN in the state of Colorado with no restrictions.
  • 3+ years of clinical experience.
  • 1+ year of experience in a home health or post-acute setting.
  • 1+ year of related experience in intake, referral processes, authorization, etc.
Preferred Qualifications
  • 3+ years of related experience preferred.
About Innovive Health

We are a leading provider of home healthcare services, dedicated to delivering high-quality care to patients with complex medical needs. Our team is passionate about innovation and excellence, and we are committed to creating a positive and supportive work environment for our employees.

What We Offer
  • Competitive salary based on experience.
  • Comprehensive benefits package, including medical, dental, vision, disability, and life insurance.
  • 24 days of paid time off.
  • Paid company holidays.
  • 401k with company match.
  • Dayforce Wallet - voluntary benefit that gives you access to earned pay.
  • Wellness program.
  • Tuition reimbursement.
  • Online CEU credits.
  • Excellent career growth opportunities.
Equal Employment Opportunity

Innovive Health is an equal employment opportunity employer and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.