Referral Review Nurse (RN)

APPLICANTS WITHOUT PRIOR HOME HEALTH REFERRAL REVIEW EXPERIENCE WILL NOT BE CONSIDERED.

At Performance Home Health, we’re dedicated to providing high-quality, patient-focused care in the comfort of our patients’ homes. We partner closely with commercial insurance providers to ensure each patient receives timely, appropriate services tailored to their needs.

Summary

Reviews incoming referrals for clinical appropriateness and payer compliance. Prior experience in referral review is required. Coding experience is also required to ensure accurate documentation that supports authorization and billing readiness.

Key Responsibilities

Each of the following responsibilities must be performed with accuracy and attention to detail:

• Review referral documentation for completeness and medical necessity; clarify missing elements with referral sources.
• Assign and validate service classifications and related documentation as required by commercial payer guidelines.
• Verify coverage criteria and confirm that documentation supports the plan of care and requested services.
• Identify discrepancies or missing information that may impact authorization and resolve before acceptance.
• Collaborate with case management and QA to ensure clean hand-offs into the EMR.
• Maintain accurate notes in the EMR and referral tracker; meet turnaround time requirements.

Required Qualifications

• Prior experience in Home Health referral review (minimum 1 year required).
• Experience with commercial insurance authorization requirements.
• Proficiency reviewing documentation and coding information to ensure compliance with payer guidelines.
• Active, unrestricted Registered Nurse (RN) license in the state of Texas (required).
• Strong attention to detail; high accuracy in data entry and documentation review.
• 1 year coding experience required

Preferred Qualifications

• Experience with EMR/Intake platforms (e.g., KanTime).
• Strong understanding of commercial payer workflows and preauthorization processes.

Job Type: Full-time

Pay: $90,000.00 - $100,000.00 per year

Benefits:

• Dental insurance
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Vision insurance

Work Location: In person