RN Clinical Authorization Nurse

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.

• 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

• 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

• 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

• Competitive Pay
• 401(k) with Company Match
• Career Advancement Opportunities
• National & Local Recognition Programs
• Teammate Assistance Fund

• 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.

• 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

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 Southern Care, Southern Care Hospice Services, Southern Care 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.

Clinical Authorization Nurse, Authorization Nurse RN, Hospice Authorization, Home Care Authorization, Eligibility Review, Medicare, Medicaid, Commercial Payers, Claims Appeals, Hospice Nursing