Authorization Specialist - Registered Nurse
The Authorization Specialist is a practice-based RN who directly deploys, supports, and educates care concepts for high-risk patients. In collaboration with other members of the healthcare team, the Authorization Specialist is responsible for identifying, organizing, coordinating, tracking, approving and providing care coordination to patients within the Comfort Care home health agencies who are most at risk for health deterioration, or poor outcomes. The Authorization Specialist is responsible for coordinating care across a diverse health care delivery team and / or multiple facility types.
- RN (bachelor’s degree preferred, but not required)
- 3 years of experience in Home Health required
- 2 years of experience in case management, disease management, and self-management support required
- 1 year of experience in performing health care authorizations required
- Must be proficient in MS office, excel and word and use of electronic medical records
- Must be able to perform in-home visits
- Must be able to perform comprehensive nursing assessments, problem identification and care plan development, disease management, screening for developmental issues, depression, other psychological conditions, and frailty behavioral strategies including motivational interviewing and self-management support
- Must be willing to achieve or maintain required certifications, training or continuing education (if applicable).
- Must be capable of completing required documentation, both paperwork and computer-based records.
- Must be willing to travel, be a licensed driver with an automobile that is insured in accordance with state/or Company requirements and is in good working order.
- Must be capable of performing the job functions of this position with or without accommodations.
ESSENTIAL JOB FUNCTIONS:
- Maintain a process to identify high-risk patients utilizing Comfort Care’s EMR system. Identify, prioritize and determine appropriate action items within one business day for patients identified as high risk.
- Maintain a tracking system for patient care coordination and case management activities (same day documentation) while on active care or in transition.
- Act as a clinical liaison for high risk patients and families.
- Assess home or social environments (as needed) through performing in home assessments, behavioral strategies, collaborating with staff or post-acute providers. Follow up with patients as appropriate.
- Serve as a resource to agency staff and patients facilitating care transitions when appropriate. Make education visits to agency locations as requested for education and coordination of complex situations.
- Assist patients in navigating the health care system, coordinate specialty care, follow-up on test results and other care coordination needs.
- Use sound, evidence based, clinical judgement within the professional scope to review, set authorization limits, and work with patients as appropriate to promote independence in the appropriate care setting.
- In collaboration with the Transitional Care Manager, develop and maintain an adequate tracking process for authorizations limits and review periods.
- Collaborate with multiple department contacts to ensure team communication in the authorization or transitional process.
- Walking, fine hand coordination, ability to read and write in English, ability to communicate with medical staff, family members and support agencies.
- Ability to remain calm under stress.
- Adhere to all of the Company’s policies and procedures.
- Performs other duties as assigned.
The above statements are intended to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.