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 YouQualifications – 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 OfferBenefits 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 positionEmployee must meet minimum requirements to be eligible for benefitsWhere applicable, employee must meet state specific requirementsWe are proud to be an EEO employerWe maintain a drug-free workplaceLocation 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 BeaconPalliative care: Empatia Palliative Care, Emerald Coast Palliative CareHome health care: Heartland Home HealthAdvanced 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.
Related Job TitlesClinical Authorization Nurse, Authorization Nurse RN, Hospice Authorization, Home Care Authorization, Eligibility Review, Medicare, Medicaid, Commercial Payers, Claims Appeals, Hospice Nursing
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