Prior Authorization (full Remote)
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Job Location:
Manchester - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
Prior Authorization Specialist (Home Health / Rehab Services)
Location:Remote Must reside in New Hampshire
Overview:
We are seeking a detail-oriented Prior Authorization Specialist to join our growing care management this role you will leverage your clinical background to review requests for home health rehabilitation and behavioral health services. You will serve as a bridge between providers payers and patients to ensure authorizations are accurate timely and aligned with medical necessity guidelines.
We are seeking a detail-oriented Prior Authorization Specialist to join our growing care management this role you will leverage your clinical background to review requests for home health rehabilitation and behavioral health services. You will serve as a bridge between providers payers and patients to ensure authorizations are accurate timely and aligned with medical necessity guidelines.
Responsibilities:
- Review medical documentation to determine medical necessity for requested services including home health rehab and behavioral health.
- Apply established criteria and clinical guidelines when approving or escalating prior authorization requests.
- Communicate authorization outcomes to providers patients and payers in a timely and professional manner.
- Collaborate with physicians nurses and case managers to clarify documentation and ensure accurate decisions.
- Maintain compliance with HIPAA payer requirements and internal policies.
Qualifications:
- Active CNA/LNA or prior clinical experience strongly preferred.
- Minimum of 2 years in home health skilled nursing rehab or behavioral health.
- Strong knowledge of ADLs clinical documentation and medical terminology.
- Proficiency with EMR/CRM systems.
- Must be a resident of New Hampshire.
Utilization Review / Care Coordinator
Location:Remote Must reside in New Hampshire
Overview:
We are hiring a Utilization Review / Care Coordinator to support medical management functions for post-acute care services. The ideal candidate has experience in patient care and understands the discharge and placement process for home health skilled nursing facilities (SNFs) and rehabilitation centers.
We are hiring a Utilization Review / Care Coordinator to support medical management functions for post-acute care services. The ideal candidate has experience in patient care and understands the discharge and placement process for home health skilled nursing facilities (SNFs) and rehabilitation centers.
Responsibilities:
- Review patient records to ensure services requested are medically appropriate and cost-effective.
- Support approvals and denials for post-acute services including SNF rehab and home health care.
- Partner with providers discharge planners and case managers to coordinate smooth transitions of care.
- Ensure clinical criteria payer requirements and state guidelines are consistently applied.
- Document all reviews approvals and communications accurately in EMR/CRM systems.
Qualifications:
- Prior clinical experience in home health rehab SNF or behavioral health required.
- Knowledge of utilization management and medical necessity criteria preferred.
- Strong organizational and communication skills.
- Proficiency in EMR and Microsoft Office or similar platforms.
- Must be a resident of New Hampshire.
Intake Coordinator / Patient Access Specialist (Home Health / Hospice)
Location:Remote Must reside in New Hampshire
Overview:
We are looking for an Intake Coordinator / Patient Access Specialist to manage incoming referrals and patient access for our home health and hospice programs. This position plays a critical role in verifying insurance ensuring eligibility and setting up care plans to provide patients with timely high-quality services.
We are looking for an Intake Coordinator / Patient Access Specialist to manage incoming referrals and patient access for our home health and hospice programs. This position plays a critical role in verifying insurance ensuring eligibility and setting up care plans to provide patients with timely high-quality services.
Responsibilities:
- Receive and process referrals from hospitals physicians and community partners.
- Verify insurance coverage and obtain required documentation for patient admission.
- Coordinate initial care plans in collaboration with clinical staff.
- Enter accurate patient and referral information into EMR/CRM systems.
- Provide compassionate communication to patients families and referral partners.
- Ensure compliance with all payer requirements HIPAA and agency standards.
Qualifications:
- Experience in healthcare intake patient access or care coordination preferred.
- Familiarity with home health hospice or post-acute services a plus.
- Strong computer skills including EMR and CRM systems.
- Excellent communication and organizational abilities.
- Must be a resident of New Hampshire.
Key Skills
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- Administration And Accounting
- Android
- Bid Management
- Inventory Management
- Embedded C
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