Clinical Liaison Referral Services Full Time Days

Clinical Liaison Referral Services Full Time Days

Requirements

• Graduate from an accredited school of nursing. Bachelor’s degree in Nursing or other health-related field, or equivalent combination of education and/or related experience.
• Three to five years clinical/nursing experience. Previous related experience with the targeted patient population preferred.
• License to practice as a Registered Nurse in the State of Michigan. License to practice as a Physical Therapist, an Occupational Therapist, or a Speech Language Pathologist in the State of Michigan.
• Analytical ability and comprehensive knowledge base to identify opportunities for improvement and problem resolution, evaluate patient status and health care procedures/techniques, and monitor quality of patient care.
• Fiscal skills to monitor and control costs and revenue; also, a working knowledge of the revenue cycle and resulting 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 diverse populations including physicians, employees, patients, and their families.
• Proficiency in application of standard appropriateness criteria sets (e.g., InterQual).
• Flexibility with schedule, including off-shifts, weekends, and holidays in order to meet the needs of patients, families or staff.
• Leadership skills to direct others toward objectives that contribute to the success of the department.
• Ability to cope with stressful situations, manage multiple and sometimes conflicting priorities simultaneously.
• Ability to integrate Third Party contractual arrangements in the pre-admission review process.

Responsibilities

• Acts as a member of the care management team by applying medical necessity criteria to determine appropriate level of care at every patient access point.
• Integrates Third Party payer specific agreement criteria, and interfaces with respective payer representatives.
• Communicates with patient, family, medical team, caregivers, and third-party payers as necessary.
• Analyzes case management outcome data to facilitate appeals and denials.
• Maintains current knowledge of health care techniques and practices by participating in educational programs.
• Participation in Utilization Review committee process as needed.
• Maintains a working knowledge of the requirements of the payers and admission criteria for this patient population.
• Responsible for pre-admission assessment of patients referred for inpatient acute services, including making recommendations for alternate levels of care within the continuum if the patient is not a candidate for admission.
• Coordinates the gathering of pertinent patient information on all referred patients from various sources including medical record, onsite and telephonic interviews and through other electronic media for the purposes of pursuing insurance authorization or ensuring reasonable and necessary admission criteria are met.
• Communicates quickly and effectively with referral sources upon decision to admit.
• Consults with other members of the interdisciplinary team regarding potential admissions, as necessary.
• Participates in quality improvement activities as directed or necessary.
• Establishes and maintains effective relationships with physicians and all other staff members, internally and externally.
• Identifies problems or any dissatisfaction experienced by any customer or referring source and works to resolve them to a high degree of service excellence.
• Effectively turns negative situations into supportive relationships by use of concern, poise, understanding, honesty, and tact.
• Exhibits behavioral skills that promote a positive customer relations environment.
• Performs other duties and functions as assigned.

Preferred Qualifications

• Previous related experience with the targeted patient population preferred.