Clinical Authorization and QA Specialist

Description

Salary: $90,000 - $105,000 per year depending on experience

Location: Overland Park, KS

Benefits Summary

• Medical, dental, vision, and 401K
• Health Savings Account (HSA)
• Matching 401k
• Unlimited Paid Time Off (PTO)
• Mileage Reimbursement

Position Summary

On behalf of CNS Cares (“CNS” or “Company”), this position is responsible for supporting the Operations team in the local state or region in the care coordination, new patient intake, plan of care development, authorizations and QA. Additionally, this position may act as the Alternate Director of Nursing in their absence.

Essential Functions

Employee must have regular attendance/punctuality, be able to work with others at all levels of the Company, have exceptional customer service, and be completely honest. Other assigned duties include:

• Ensure excellent quality of patient care is delivered to respective patients in assigned region.
• Ensure that each patient admitted has appropriate documentation completed and that each patient receives the patient's bill of rights/consumer rights.
• Assist in coordinating case management for assigned region and provides case management as directed by leadership.
• Review/audit of clinical records and field staff documentation.
• Educates staff about any clinical documentation issues found,
• Have exceptional attention to detail.
• Establish and promote a collaborative relationship with patient, physicians, payers, and other members of the health-care team.
• Evaluates the medical necessity and appropriateness of ordered level of care, utilizing standard criteria and clinical judgment to optimize patient outcomes
• Collects and communicates pertinent, timely information to all necessary team members
• Maintains a 100% monthly average of controllable submissions to DOL prior to the patient’s expiration date.
• Creates plans of care according to state and accrediting body regulations and maintains 100% monthly average of controllable up to date plans of care
• Provide timely documentation regarding the status of the patient during the start of care or reauthorization process.
• Track the authorization status of the patient and begin reauthorization tasks 90-days prior to the end of authorization.
• Coordinate and attend face to face appointments as needed for re-authorization.
• Demonstrates current knowledge of Payor policy and procedure(s).
• Assists in overseeing licensed nurse competence, in the state of oversight, relative to home health nursing assessment and appropriate nursing interventions.
• Demonstrates leadership in the implementation of quality improvement changes within the organization for improvement of patient care.
• Ensures compliance with government rules and regulations in the state of oversight, including the submission of any reports to agencies, as required.
• Sets the tone for professional and ethical compliance practices of licensed and non-licensed personnel.
• Demonstrates effective delegation of tasks, working with and through others as needed.
• Ensures medical records are completed correctly and adequately across the continuum of the company.
• Assists in quality and committee initiatives, in the state of oversight, such as Infection Control, Performance Improvement, Customer Satisfaction, and Safety.
• Demonstrates leadership in all required clinical accountabilityAssists with surveys and preparation.
• Participates in public relations and community activities that promote CNS’s role as an effective provider of in-home care.
• Considers age-related factors with patient care for the adult and elderly when providing home care.
• Support the State Administrator in assuring that all facilities or office space in assigned region follow corporate policies and procedures.
• Provide follow-up and documentation on incident reports.
• Attends start of care and renewal appointments with patients
• Case load depends on acuity and needs of the state or region assigned and may vary by state or region.
• Other duties as assigned.

SUPERVISORY RESPONSIBILITIES

This position has direct supervisory responsibilities as assigned.

Requirements

Education/Training

Required:

• Must be at least 21 years of age
• Must have a Bachelors degree or Associates degree in nursing.
• Must have a current, valid Registered Nursing (RN) License.
• Must reside in the state of Kansas or reside in Missouri in a county that directly boarders the state of Kansas.

Preferred:

• Home health or hospice experience strongly preferred.
• Leadership or supervisory experience in home healthcare strongly preferred.
• Department of Labor (DOL) / EEOICPA experience strongly preferred.
• Bachelors degree in nursing preferred.

Licensure/Certification

• Valid Driver’s License
• Valid and current CPR Certification
• Valid Registered Nurse (RN) license in States practicing

#TFIND