Clinical Liaison RN

Wellstar Health System

2d • Onsite

About The Position

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
• 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
• Minimum 2 years of clinical experience directly related to ICU/IMCU patients in acute setting
• 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
• 1 year LTAC or previous liaison experience

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

• Nationally ranked and locally recognized for our high-quality care and inclusive culture
• Featured on the FORTUNE “100 Best Companies to Work For” list and Seramount 100 Best Companies list

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees