Registered Nurse (RN)- Clinical Liaison

Wellstar Health System•Marietta, GA

10d

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 Day (United States of America) Click Here to Visit the Windy Hill Hospital Website 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.

Requirements

Graduate of an accredited/approved school of nursing
Bachelor's Degree
Baccalaureate degree in nursing (BSN) from an accredited school of nursing
Respiratory Care Prof Reg
Nurse (Single State)
RN - Multi-state Compact
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/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.

Nice To Haves

Graduate of an accredited respiratory therapy education program (CoARC or CAAHP) with minimally 20 quarter hours of science.
Associate's Degree A.S Degree
Bachelor's Degree B.S Degree
LTAC or previous liaison experience

Responsibilities

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.