Natalie D. Welch OTR/L, CLT

Responsible for managing authorization requests for home health services in accordance with CMS guidelines and nationally recognized standards. As part of the Home Health team, I review clinical documentation from home health providers (OTs, PTs, SLPs, and Skilled Nursing) to evaluate the medical necessity of home health services using internally developed clinical criteria. HHCC collaborate with Medical Directors and care management staff to determine the best course of action based on clinical factors.

Key Responsibilities:

• Apply CMS Chapter 7 guidelines for home health to assess authorization requests
• Follow up with providers to clarify clinical documentation of patients' status
• Collaborate with intake, home health, appeals/denials teams, and Medical Directors to ensure timely and accurate processing of authorization requests in line with turnaround times and quality metrics
• Communicate denials to healthcare providers as reviewed by Medical Directors
• Review departmental reports on key quality metrics and identify opportunities for process improvement
• Participate in cross-training initiatives and maintain knowledge of multiple contracts/clients to support business coverage needs

• Occupational Therapist providing care to patients in SNF/Outpatient setting due to injury, trauma or physical impairment in order to reach highest level of independence
• Creates individualized treatment plans tailored to the needs of clients with patient populations to include stroke, Parkinson, amputees, cardiac, orthopedic and dementia patients

• Responsible for evaluating and treating patients in their home environment to determine how to improve on their functional abilities to optimize their independence and their abilities to accomplish daily activities following injury, trauma or physical impairment