Clinical Liaison

Tenet•Detroit, MI

About The Position

Under limited direction and according to established policies and procedures, the Clinical Liaison acts as a member of the care management team, applying medical necessity criteria to determine the appropriate level of care at each patient access point. Access points may include acute care hospitals, post-acute venues, clinics, or patients’ homes. The role integrates third-party payer-specific agreement criteria and interfaces with payer representatives. It communicates with patients, families, the medical team, caregivers, and third-party payers as needed, and analyzes case management outcome data to support appeals and denials. The Clinical Liaison conducts pre-admission assessments for patients referred for inpatient acute services and recommends alternate levels of care within the continuum when a patient is not a candidate for admission. The role coordinates collection of pertinent patient information from medical records, onsite and telephone interviews, and other electronic sources to pursue insurance authorization or confirm that reasonable and necessary admission criteria are met. It communicates admission decisions promptly to referral sources and consults with interdisciplinary team members about potential admissions as needed. The position maintains current knowledge of healthcare techniques, practices, payer requirements, and admission criteria for the patient population. It participates in educational programs, the Utilization Review committee process as needed, and quality improvement activities as directed or necessary. The Clinical Liaison builds effective relationships with physicians and staff, identifies and resolves concerns from customers and referring sources, and promotes positive customer relations. Other duties and functions may be assigned. The role is based at DMC Rehabilitation Institute of Michigan, a rehabilitation medicine and research hospital specializing in areas including spinal cord injury, brain injury, stroke, amputee, orthopedics, and catastrophic injury care. The facility also operates outpatient sites throughout southeast Michigan specializing in sports medicine and orthopedics.

Requirements

Graduate from an accredited school of nursing.
Bachelor’s degree in Nursing or another health-related field, or an equivalent combination of education and/or related experience.
Three to five years of clinical or nursing experience.
License to practice as a Registered Nurse in the State of Michigan, or license to practice as a Physical Therapist, Occupational Therapist, or Speech Language Pathologist in the State of Michigan.
Analytical ability and comprehensive knowledge to identify improvement opportunities, resolve problems, evaluate patient status and healthcare procedures or techniques, and monitor quality of patient care.
Fiscal skills to monitor and control costs and revenue, and working knowledge of the revenue cycle and the impact of utilization management decisions.
Interpersonal skills to work productively with all levels of hospital personnel.
Verbal and written communication skills to communicate effectively with physicians, employees, patients, families, and diverse populations.
Proficiency in applying standard appropriateness criteria sets, such as InterQual.
Flexibility with schedule, including off-shifts, weekends, and holidays, to meet the needs of patients, families, or staff.
Leadership skills to direct others toward objectives that contribute to departmental success.
Ability to cope with stressful situations and manage multiple, sometimes conflicting, priorities simultaneously.
Ability to integrate third-party contractual arrangements into the pre-admission review process.

Nice To Haves

Previous related experience with the targeted patient population.

Responsibilities

Apply medical necessity criteria to determine the appropriate level of care at patient access points.
Integrate third-party payer-specific agreement criteria and communicate with payer representatives.
Communicate with patients, families, the medical team, caregivers, and third-party payers as necessary.
Analyze case management outcome data to facilitate appeals and denials.
Maintain current knowledge of healthcare techniques, practices, payer requirements, and admission criteria for the patient population.
Participate in educational programs and the Utilization Review committee process as needed.
Conduct pre-admission assessments for patients referred for inpatient acute services.
Recommend alternate levels of care when a patient is not a candidate for admission.
Coordinate collection of pertinent patient information from medical records, onsite and telephone interviews, and electronic sources for insurance authorization or admission-criteria review.
Communicate admission decisions quickly and effectively to referral sources.
Consult with interdisciplinary team members regarding potential admissions as necessary.
Participate in quality improvement activities as directed or necessary.
Establish and maintain effective relationships with physicians and other internal and external staff.
Identify and resolve problems or dissatisfaction raised by customers or referring sources.
Promote positive customer relations and turn negative situations into supportive relationships.
Perform other duties and functions as assigned.