This position is an office position for an experienced registered nurse. The position requires review of medical records and documentation in order to determine appropriate clinical processes for home health care services. Case managers are not required to be out in the field.
RESPONSIBILITIES AND DUTIES
Responsibilities of RN include, but are not limited to the following:
- Processes patient reauthorization requests as outlined by company policy.
- Makes determination of the need for continued home health care services by reviewing documentation submitted by providers in accordance with Medicare guidelines.
- Maintains accurate records of authorizations and communication with providers and payer plans pertaining to authorization for all patients.
- Assists provider staff and team members in identifying patient needs and coordinating care.
- Assists provider staff and team members in efficient and cost-effective utilization of health care resources and monitors patient progress and outcomes.
- Facilitates communication and provides ongoing customer service support to payer plan case managers, patients and provider staff and team members.
- Prepares and submits any required status or summary reports in a timely manner.
Must have excellent computer skills and be a self starter
Must be able to read through various forms of medical documentation in a timely manner
Detailed oriented person with excellent written and oral communication skills
Must be able to follow Medicare guidelines accordingly