Location
Marietta, GA | United States
Job description
Overview The Clinical Liaison is a member of the care coordination department and is responsible for participating in the referral coordination for local hospitals. He/she functions as a marketing representative for clinical referrals. He/she interacts with the case managers, admission coordinator, and other liaisons on site. He/she regularly reviews the clinical chart of potential long-term acute care patients and begins the admissions process with the help of the admissions coordinator. In addition the clinical liaison uses InterQual, NALTH criteria to assess patients. He/she will function as a sales, marketing, and clinical specialist for the hospital. Role requires basic understanding of Medicare, Medicaid, and private insurance.
Responsibilities Core Responsibilites and Essential Functions
- Conducts a review of data to determine admission eligibility and an individual?s health care needs or needs for services.
* Reviews information from referring facilities.
* Reviews screening assessment for necessity and appropriateness of health services by the application of established screening criteria (i.e. NALTH, InterQual, etc?)
* Timely identification and referral for alternative level of care.
* Completes and coordinates paperwork as required by post-discharge providers. - Identifies potential care needs based on assessment.
* Assesses insurance and coverage issues such as managed care, PPO, HMO, and the identification of preferred providers.
* Identifies issues relating to patient type and/or appropriateness of admission and/or continued stay and collaborates with physician/physician advisor for resolution. - Monitor for compliance of Medicare/Medicaid regulations (i.e. order for patient type of billing, appropriate billing, etc?).
* Review insurance of potential patients and discuss validity and discharge plan with patient/family.
* Assess various forms of insurance for in-network vs. out-of-network benefits.
* Begin the precertification process: calling insurance companies for authorizations and checking Medicare days.
Required for All Jobs
- Performs other duties as assigned
- Complies with all WellStar Health System policies, standards of work, and code of conduct.
Qualifications Required Minimum Education
- Graduate of an accredited/approved school of nursing Required and
- Bachelor's Degree Baccalaureate degree in nursing (BSN) from an accredited school of nursing Preferred or
- Graduate of an accredited respiratory therapy education program (CoARC or CAAHP) with minimally 20 quarter hours of science. Required and
- Associate's Degree A.S Degree Required or
- Bachelor's Degree B.S Degree Preferred
Required Minimum Experience
- Minimum 2 years of clinical experience directly related to ICU/IMCU patients in acute setting Preferred and
- LTAC or previous liaison experience Preferred
Required Minimum Skills
- Must have excellent communication skills, able to handle incoming and outgoing calls, visitors, and other customers in a professional and courteous manner.
- Must be organized and capable of handling multiple tasks at once.
- Demonstrates ability to interview patients, staff and visitors with effective written and/or verbal communication skills.
- Knowledgeable of screening criteria in review of clinical data with respect to patients/client?s needs for healthcare.
- Ability to effect change performs critical analysis, promote client/family autonomy and plan and organize effectively for the continuum of care.
- Have knowledge of funding resources, community resources, services and clinical standards and outcomes.
Required Minimum License(s) and Certification(s)
- Respiratory Care Prof 1.00 Required 1.00
- Reg Nurse (Single State) 1.00 Required 1.00
- RN - Multi-state Compact 1.00 Required 1.00
Additional Licenses and Certifications
We’d like to invite you on a career journey like no other! In return for your contributions, we’ll help you make the most of all life’s moments – on and off the job. Wellstar Total Rewards is designed to provide for your total well-being, including: Your Wellness, Your Pay, Your Future, Your Joy. We think it’s pretty simple – we care for our team members and our team members care for the community.
Make a difference in patients’ lives… and your own! Here, it’s more than healthcare – it’s CareerCare!
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