Rehab Care Coordination Specialist FT Days

Trane Technologies•Detroit, MI

About The Position

DMC Rehabilitation Institute of Michigan (RIM) is a large hospital specializing in rehabilitation medicine and research, with expertise in spinal cord injury, brain injury, stroke, amputee, orthopedics, and catastrophic injury care. RIM also operates outpatient sites throughout southeast Michigan focused on sports medicine and orthopedics. Under general direction and according to established policies and procedures, the Rehab Care Coordination Specialist develops and supervises interdisciplinary treatment plans for inpatient rehabilitation patients. The specialist collaborates with the care team to facilitate quality, timely care at the appropriate level, reviews services and patient progress, and maintains communication with families and professionals. The role coordinates interdisciplinary team meetings, recommends services based on patient assessments and relevant preferences, and continually assesses level of care, clinical risk, diagnostic testing, and procedures. The specialist leads discharge planning with the treatment team and patient or family, evaluates discharge-plan effectiveness, and provides follow-up troubleshooting after discharge. The position also serves as a patient advocate, documents assessments and progress, and refers medical necessity, utilization, or quality concerns to management and a physician advisor. The specialist coordinates utilization review for assigned patients, conducts concurrent reviews and quality screening, contacts third-party payers for recertification, supports reimbursement and quality reviews, and assists with appeals. The role educates multidisciplinary team members about admission, continued-stay, and medical-necessity criteria, payer regulations, and discharge planning. It also supports compliance with TJC and CARF standards, rehabilitation policies and procedures, and ongoing performance improvement. Other duties may be assigned.

Requirements

Master's degree in Social Work, Speech Language Pathology, or a related clinical field; or bachelor's degree in Physical Therapy, Occupational Therapy, Nursing, or a related clinical field; or an equivalent combination of education and related experience.
Current license, registration, and/or certification, as applicable.
Three years of clinical experience.

Nice To Haves

Case management certification preferred.

Responsibilities

Develop and supervise implementation of interdisciplinary treatment plans for inpatient rehabilitation patients.
Collaborate with care-team members to facilitate quality, timely care at the most appropriate level.
Review services and patient progress and maintain communication with families and professionals.
Coordinate interdisciplinary team meetings involving the team, patient and family, insurance representatives, and other appropriate participants.
Recommend services based on patient assessments, case documents, and patient, family, or insurance-carrier preferences.
Assess level of care, diagnostic testing and procedures, quality, and clinical risk; participate in continuous performance improvement.
Direct discharge planning in collaboration with the treatment team and patient or family, evaluate the plan, and troubleshoot issues after discharge.
Advocate for patients and provide therapeutic intervention or support as needed.
Provide verbal and written documentation of assessments and client progress to appropriate parties.
Refer concerns about medical necessity, inappropriate resource utilization, or quality to management and a physician advisor.
Identify non-acute days and discharge delays and assess their causes.
Build effective relationships with physicians and staff, identify customer or referring-source dissatisfaction, and work to resolve concerns.
Use interpersonal skills to resolve conflict and promote positive customer relations.
Coordinate utilization review for assigned patients and conduct periodic concurrent reviews to assess continued-stay needs.
Contact third-party payers for cases requiring recertification and conduct reviews to support reimbursement determinations or assess quality issues.
Participate in concurrent quality screening, collect data, and refer matters to Quality Management or Risk Management as appropriate.
Stay current on external agency regulations and assist with third-party payer appeals.
Educate multidisciplinary team members about admission, continued-stay, and medical-necessity criteria, payer regulations, and discharge planning.
Provide resources regarding insurance issues and assist with monitoring performance against TJC and CARF standards.
Assist in creating and implementing rehabilitation policies, procedures, goals, and objectives.
Maintain current knowledge of healthcare practices and care-management strategies, along with payer requirements relevant to the patient population.
Troubleshoot patient issues with patient accounting as needed.
Perform other assigned duties and functions.