Remote RN OASIS Auditor & Prior Authorization Specialist

Galaxy Personal Care Services LLC; Indianapolis (IN); Remote; USD 70,000 - 95,000; Full time

Benefits offered by this job

Flexible work from home options

Job summary

Galaxy Personal Care Services LLC is seeking an experienced Registered Nurse to serve as an OASIS Auditor and Prior Authorization Specialist in our home health operations. The RN will review OASIS assessments and clinical documentation for accuracy, regulatory compliance, medical necessity, and alignment with the Plan of Care.

The role includes coordinating and submitting prior authorization requests to Medicaid MCEs and other payers, supporting remediation, and educating clinicians on

Qualifications

• Active RN license in good standing.
• OASIS auditing experience required.
• Knowledge of Medicare/Medicaid home health documentation requirements.
• Prior authorization or utilization-review experience preferred.
• Ability to interpret clinical records and demonstrate medical necessity clearly.

Responsibilities

• Review SOC, ROC, Recertification, Transfer, and Discharge OASIS assessments for accuracy and completeness.
• Audit OASIS documentation for consistency with the assessment, diagnoses, functional status, skilled needs, homebound status, and Plan of Care.
• Identify documentation discrepancies and potential compliance concerns.
• Provide clinicians with corrections and recommendations before final submission when appropriate.
• Review documentation for support of skilled nursing, therapy, and home health aide services.
• Monitor documentation and OASIS completion timeliness.
• Assist with regulatory surveys, internal audits, QAPI activities, and payer reviews.
• Educate clinical staff regarding documentation deficiencies and opportunities for improvement.

Skills

OASIS auditing

Prior authorization

Home health nursing

Regulatory knowledge

Clinical documentation review

Communication

Education

Registered Nurse license

Tools

Home health EMR systems

Job description

Galaxy Personal Care Services LLC is seeking an experienced Registered Nurse to serve as an OASIS Auditor and Prior Authorization Specialist in our home health operations. The RN will review OASIS assessments and clinical documentation for accuracy, regulatory compliance, medical necessity, and alignment with the Plan of Care.

The role includes coordinating and submitting prior authorization requests to Medicaid MCEs and other payers, supporting remediation, and educating clinicians on