Clinical Authorization Auditor - LPN/LVN

The clinical authorization auditor is an experienced home health LVN/LPN that performs clinical reviews and evaluates the appropriateness of clinical services. This position reviews clinical documentation and makes recommendations for appropriate utilization. The clinical authorization auditor acts as a resource to Enhabit Home Health & Hospice branches and home office with regard to federal, state, and agency regulations for home health and hospice.

This is a remote position, but applicant must live in a state that we do business in.

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

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

3. Maintain communication with branches; insurance carrier contractual or regulatory requirements.

4 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.

5. 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.

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

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

8. Complete all other duties as assigned.

Qualifications:

• 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.
• Previous experience planning and presenting on educational topics is preferred.
• Demonstrated understanding of OASIS documentation regulations and procedures is highly preferred.
• 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

At Enhabit, the best of what’s next starts with us. We not only make it a priority to maintain an ethical and stable workplace but also continually invest in our employees. By extending ongoing professional development opportunities and providing cutting-edge technology solutions, we ensure our employees are always moving their careers forward and prepared to deliver a better way to care for our patients.

Ever-mindful of the need for employees to care for themselves and their families, Enhabit offers competitive benefits that support and promote healthy lifestyle choices. Subject to employee eligibility, some benefits, tools and resources include:

• 30 days PDO – Up to 6 weeks (PDO includes company observed holidays)
• Continuing education opportunities
• Scholarship program for employees
• Matching 401(k) plan for all employees
• Comprehensive insurance plans for medical, dental and vision coverage for full-time employees
• Supplemental insurance policies for life, disability, critical illness, hospital indemnity and accident insurance plans for full-time employees
• Flexible spending account plans for full-time employees
• Minimum essential coverage health insurance plan for all employees
• Electronic medical records and mobile devices for all clinicians
• Incentivized bonus plan

Enhabit Home Health & Hospice is an equal opportunity employer. We work to promote differences in a collaborative and respectful manner. We are committed to a work environment that supports, encourages and motivates all individuals without discrimination on the basis of race, color, religion, sex (including pregnancy or related medical conditions), sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, genetic information, or other protected characteristic. At Enhabit, we celebrate and embrace the special differences that makes our community extraordinary.