RN Clinical Authorization Nurse at Illumia

Mooresville, North Carolina, United States -

Full Time

Start Date

Immediate

Expiry Date

09 May, 26

Salary

0.0

Posted On

08 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Registered Nurse License, Home Care Experience, Hospice Knowledge, Payer Eligibility Requirements, Claims Processes, Medical Record Review, Documentation Management, Communication Skills, Organization Skills, Problem-Solving Skills, Attention To Detail, Computer Proficiency, Compliance Knowledge, Team Collaboration, Performance Metrics Analysis

Industry

Hospitals and Health Care

Description

Overview Ensuring Compliance. Streamlining Authorizations. Supporting Patient Care. The Clinical Authorization Nurse plays a key role in supporting our authorizations department by reviewing clinical information requirements from Medicare, Medicaid, and commercial payer policies. This position oversees authorization and eligibility processes, working closely with billing, collections, and field staff to ensure compliance and smooth claims processing. As a Clinical Authorization Nurse, You Will: Perform reviews of medical records and documentation with an emphasis on payer eligibility requirements Compile patient medical record information to meet the standards of Medicare, Medicaid, and commercial policies Partner with staff on obtaining documentation necessary for clean claim billing Manage and communicate with the team regarding the appeals process for claims Collaborate with Directors of Billing and Collections to maintain compliance with MCD/MCR, state and federal regulations, NHPCO standards, and ACHC standards Develop and maintain tracking logs and spreadsheets related to claims processing Support senior management in the development and analysis of performance metrics to ensure operations align with strategic goals Work cooperatively with field staff and leadership to address compliance and documentation needs Demonstrate strong communication skills across all levels of the organization Uphold the company’s core values and maintain confidentiality in all work About You Qualifications – What You’ll Bring: Registered Nurse license Three years of experience in home care or hospice Strong knowledge of payer eligibility requirements and claims processes Ability to handle confidential information with integrity Excellent organization and problem-solving skills Proficiency with multiple computer systems and applications Strong communication skills with field staff, management, and executives Ability to manage multiple priorities with strong attention to detail and follow-up Preferred Qualifications (Not Required): Bachelor’s degree in Nursing or related field Experience working directly with appeals processes for Medicare, Medicaid, and commercial policies Familiarity with NHPCO and ACHC compliance standards We Offer Benefits for All Associates (Full-Time, Part-Time & Per Diem): • Competitive Pay• 401(k) with Company Match• Career Advancement Opportunities• National & Local Recognition Programs• Teammate Assistance Fund Additional Full-Time Benefits: • Medical, Dental, Vision Insurance• Mileage Reimbursement or Fleet Vehicle Program• Generous Paid Time Off + 7 Paid Holidays• Wellness Programs (Telemedicine, Diabetes Management, Joint & Spine Concierge Care)• Education Support & Tuition Assistance• Free Continuing Education Units (CEUs)• Company-paid Life & Long-Term Disability Insurance• Voluntary Benefits (Pet, Critical Illness, Accident, LTC) Apply today and help ensure patients receive the care they deserve with the support they need. Legalese This is a safety-sensitive position Employee must meet minimum requirements to be eligible for benefits Where applicable, employee must meet state specific requirements We are proud to be an EEO employer We maintain a drug-free workplace Location Gentiva Hospice Our Company At Gentiva, it is our privilege to offer compassionate care in the comfort of wherever our patients call home. We are a national leader in hospice care, palliative care, home health care, and advanced illness management, with nearly 600 locations and thousands of dedicated clinicians across 38 states. Our place is by the side of those who need us – from helping people recover from illness, injury, or surgery in the comfort of their homes to guiding patients and their families through the physical, emotional, and spiritual effects of a serious illness or terminal diagnosis. Our nationwide reach is powered by a family of trusted brands that include: Hospice care: Gentiva Hospice, Emerald Coast Hospice Care, Heartland Hospice, Hospice Plus, New Century Hospice, Regency SouthernCare, SouthernCare Hospice Services, SouthernCare New Beacon Palliative care: Empatia Palliative Care, Emerald Coast Palliative Care Home health care: Heartland Home Health Advanced illness management: Illumia Health With corporate headquarters in Atlanta, Georgia, and providers delivering care across the U.S., we are proud to offer rewarding careers in a collaborative environment where inspiring achievements are recognized – and kindness is celebrated.

Responsibilities

The Clinical Authorization Nurse reviews clinical information for authorizations, ensuring compliance with payer policies. They manage the authorization process and collaborate with various teams to support claims processing.