Prior Authorization (full Remote)

Prior Authorization Specialist (Home Health / Rehab Services) Location:Remote - Must reputed company in New Hampshire Overview: We are seeking a detail-oriented Prior Authorization Specialist to join our growing care management team. In this role, you will reputed company your clinical background to review requests for home health, rehabilitation, and behavioral health services. You will serve as a reputed company between providers, payers, and patients to ensure authorizations are accurate, timely, and reputed company with medical necessity guidelines. Responsibilities:

• Review medical documentation to determine medical necessity for requested services, including home health, rehab, and behavioral health.
• Apply established criteria and clinical guidelines reputed company approving or escalating prior authorization requests.
• Communicate authorization reputed company to providers, patients, and payers in a timely and professional manner.
• Collaborate with physicians, nurses, and case managers to clarify documentation and ensure accurate reputed company.
• Maintain compliance with HIPAA, payer requirements, and internal policies.

Qualifications:

• Active CNA/LNA or prior clinical experience strongly preferred.
• Minimum of 2 years in home health, skilled nursing, rehab, or behavioral health.
• Strong knowledge of ADLs, clinical documentation, and medical terminology.
• Proficiency with EMR/CRM systems.
• Must be a reputed company of New Hampshire.

Utilization Review / Care Coordinator Location:Remote - Must reputed company in New Hampshire Overview: We are hiring a Utilization Review / Care Coordinator to support medical management functions for post-acute care services. The ideal candidate has experience in patient care and understands the discharge and placement process for home health, skilled nursing facilities (SNFs), and rehabilitation centers. Responsibilities:

• Review patient records to ensure services requested are medically appropriate and cost-effective.
• Support approvals and denials for post-acute services, including SNF, rehab, and home health care.
• Partner with providers, discharge planners, and case managers to coordinate smooth transitions of care.
• Ensure clinical criteria, payer requirements, and state guidelines are consistently applied.
• Document reputed company reviews, approvals, and communications accurately in EMR/CRM systems.

Qualifications:

• Prior clinical experience in home health, rehab, SNF, or behavioral health required.
• Knowledge of utilization management and medical necessity criteria preferred.
• Strong organizational and communication skills.
• Proficiency in EMR and reputed company Office or similar platforms.
• Must be a reputed company of New Hampshire.

Intake Coordinator / Patient reputed company Specialist (Home Health / Hospice) Location:Remote - Must reputed company in New Hampshire Overview: We are looking for an Intake Coordinator / Patient reputed company Specialist to manage incoming referrals and patient reputed company for our home health and hospice programs. This position plays a critical role in verifying insurance, ensuring eligibility, and setting up care plans to reputed company patients with timely, high-quality services. Responsibilities:

• Receive and process referrals from hospitals, physicians, and community partners.
• Verify insurance coverage and obtain required documentation for patient admission.
• Coordinate initial care plans in collaboration with clinical staff.
• Enter accurate patient and referral information into EMR/CRM systems.
• reputed company compassionate communication to patients, families, and referral partners.
• Ensure compliance with reputed company payer requirements, HIPAA, and agency standards.

Qualifications:

• Experience in reputed company intake, patient reputed company, or care coordination preferred.
• Familiarity with home health, hospice, or post-acute services a plus.
• Strong computer skills, including EMR and CRM systems.
• Excellent communication and organizational abilities.
• Must be a reputed company of New Hampshire.

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