Hybrid Clinical Liaison bei Wellstar

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

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• 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.

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.

QUALIFICATIONS

Required Minimum Education:

• Graduate of an accredited/approved school of nursing
• Bachelor's Degree Baccalaureate degree in nursing (BSN) from an accredited school of nursing Preferred
• Graduate of an accredited respiratory therapy education program (CoARC or CAAHP) with minimally 20 quarter hours of science.
• Associate's Degree A.S Degree Required
• Bachelor's Degree B.S Degree Preferred

Required Minimum License(s) and Certification(s):

• Respiratory Care Prof
• Reg Nurse (Single State)
• RN - Multi-state Compact

Required Minimum Experience:

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

Required Minimum Skills:

• 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.

Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.