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Work Shift

Day (United States of America)

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The Clinical Liaison is a member of the care coordination department and is responsible for participating in the referral coordination for local hospitals.Functions as a marketing representative for clinical referrals.Interacts with the case managers, admission coordinator, and other liaisons on site.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.Will function as a sales, marketing, and clinical specialist for the hospital. Role requires basic understanding of Medicare, Medicaid, and private insurance.

RESPONSIBILITIESConducts 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.

QUALIFICATIONS

Required Minimum Education:

Graduate of an accredited/approved school of nursingBachelor's Degree Baccalaureate degree in nursing (BSN) from an accredited school of nursing PreferredGraduate of an accredited respiratory therapy education program (CoARC or CAAHP) with minimally 20 quarter hours of science.Associate's Degree A.S Degree RequiredBachelor's Degree B.S Degree Preferred

Required Minimum License(s) and Certification(s):

Respiratory Care ProfReg Nurse (Single State)RN - Multi-state Compact

Required Minimum Experience:

Minimum 2 years of clinical experience directly related to ICU/IMCU patients in acute setting PreferredLTAC 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.

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