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Enhabit Home Health & Hospice · 3 hours ago

Clinical Authorization Auditor - LPN/LVN

United States

Full-time

Remote

Entry Level

1+ years exp

Enhabit Home Health & Hospice is a provider of home health and hospice services, seeking a Clinical Authorization Auditor who is an experienced LVN/LPN. This role involves performing clinical reviews, evaluating service appropriateness, and ensuring compliance with regulations while acting as a resource for branches and the home office.

Health CareHome Health CareMedicalNursing and Residential Care

Responsibilities

Complete clinical record reviews and make recommendations; evaluate the appropriateness of proposed clinical services provided

Complete timely follow-up on requested authorizations; utilize Homecare Homebase (HCHB) workflow and address pending requests

Maintain communication with branches; insurance carrier contractual or regulatory requirements

Review and evaluate branch adherence to the Enhabit Home Health and Hospice compliance program and make recommendations where needed to correct deficiencies; act as a compliance liaison for Enhabit Home Health and Hospice at all times

Review and evaluate branch compliance to external regulators and make recommendations where needed to correct deficiencies; Occupational Safety and Heath Administration (OSHA) and other safety regulations, Medicare conditions of participation, and state laws and regulations

Assist with resolution of operational and software help issues related to clinical authorizations; ensure task are completed accurately and timely

Monitor branch authorization workflow and actions screens in HCHB, as needed

Complete all other duties as assigned

Qualification

Licensed LPN/LVNClinical documentation reviewFederal/state regulations knowledgeOASIS documentation understandingAdvanced technology skillsEducational presentation experience

Required

Must be a graduate of an approved school of nursing and a licensed LPN/LVN in the state where they currently practice

Must have at least one year experience as a licensed professional

Must have demonstrated experience and understanding of federal, state, and local laws and regulatory guidelines governing the operations of Medicare certified home health and hospice

Advanced technology skills using computers and mobile devices is a must

Must possess a valid state driver license

Must maintain automobile liability insurance as required by law