Clinical Liaison RN
About The Position
How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives. Work Shift Various (United States of America) Job Summary: 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.
Requirements
- Associates Nursing Required
- RN - Reg Nurse (Single State) or RN-COMPACT - RN - Multi-state Compact
- BLS - Basic Life Support from the American Red Cross or American Heart Association
- 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/clients 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.
Nice To Haves
- Bachelors Nursing-Preferred
- Minimum 2 years of clinical experience directly related to ICU/IMCU patients in acute setting Preferred
- Minimum 1 year LTAC or previous liaison experience Preferred
Responsibilities
- Conducts a review of data to determine admission eligibility and an individuals 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.
- Performs other duties as assigned
- Complies with all Wellstar Health System policies, standards of work, and code of conduct.
Benefits
- Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
Number of Employees
5,001-10,000 employees
