Prior Authorization (full Remote)

Prior Authorization Specialist (Home Health / Rehab Services) Location:Remote - Must reside 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 leverage your clinical background to review requests for home health, rehabilitation, and behavioral health services. You will serve as a bridge between providers, payers, and patients to ensure authorizations are accurate, timely, and aligned 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 when approving or escalating prior authorization requests.
• Communicate authorization outcomes to providers, patients, and payers in a timely and professional manner.
• Collaborate with physicians, nurses, and case managers to clarify documentation and ensure accurate decisions.
• 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 resident of New Hampshire. Utilization Review / Care Coordinator Location:Remote - Must reside 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 all 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 Microsoft Office or similar platforms.
• Must be a resident of New Hampshire. Intake Coordinator / Patient Access Specialist (Home Health / Hospice) Location:Remote - Must reside in New Hampshire Overview: We are looking for an Intake Coordinator / Patient Access Specialist to manage incoming referrals and patient access for our home health and hospice programs. This position plays a critical role in verifying insurance, ensuring eligibility, and setting up care plans to provide 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.
• Provide compassionate communication to patients, families, and referral partners.
• Ensure compliance with all payer requirements, HIPAA, and agency standards. Qualifications:
• Experience in healthcare intake, patient access, 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 resident of New Hampshire. Apply tot his job Apply To this Job

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