The rehabilitation Admission Liaison performs activities and duties related to preadmission assessment screening and admission of clients to the Fudge Family Acute Rehabilitation Center. The liaison proactively identifies clients who meet program criteria and will benefit from program services. The Liaison initiates and develops relationships with current and potential referral sources and patients in acute care to provide an understanding the acute rehabilitation services including expectations for participation and hours of therapy as well as efficient utilization of program services and available resources. Assists patients with facilitating the process for admission to the rehabilitation hospital. Determines eligibility by verifying coverage information, ensuring that the patient meets IRF criteria for admission, and securing physician acceptance/approval by providing detailed documentation in the pre-admission screen. Provides coordination of a smooth transition from the referring facility or site to the rehabilitation setting. Recommends appropriate level of care and services for clients who are denied admission and provides guidance for clients who may benefit from rehabilitation admission in the future. The Admissions Liaison maintains optimal unit census through coordination of admissions and discharges while staying informed and compliant with the 60/40 rule. Essential Functions
Attends to telephone inquiries from patients, case managers, physicians, and outside agencies. Explains the preadmission process. Performs on site and/or record review, including telephone preadmission screening and clinical assessment.
Accurately completes all required preadmission screening documentation to determine that services are appropriate, reasonable and necessary.
Appropriately recommends candidates for admission and considers financial issues as well as discharge disposition of patient.
Ensures that referrals are reviewed and medically approved by Medical Director or covering rehab physician.
Assists in facilitating benefit eligibility and precertification, including providing a plan of care and participating in external payer negotiations. Assists in overseeing the workflow relating to pre-admissions.
Creates target lists of contacts and decision makers in assigned hospitals and enters data into shared folder.
Educates clients, family members or significant others, referral sources, interdisciplinary team members, external payers, and external case managers about rehabilitation program benefits and services including expectations for participation and hours of therapy per day. Serves as the liaison case manager with the internal and external case managers to provide an appropriate and cost-effective plan for each client while developing positive relationship with referral sources.
Demonstrates effective communication between internal and external customers at all times. Maintains high ethical standards.
Serves as a rehabilitation consultant, with attention to the client’s rehabilitation potential, therapy and functional progress, discharge plan and feasibility, special equipment needs, rehabilitation services across the continuum of care, and care transitions. Maintains a thorough knowledge of rehabilitation settings, post-acute care services, acuity trends and outcomes.
Assumes accountability for outreach activities, including data management and outcomes analysis.
Develops rapport with clients and their family members or significant others. Provides outcome data.
Contacts insurance carriers (for non-Medicare patients) to confirm coverage, verify benefits and obtain authorization/precertification to ensure reimbursement.
Notifies referring hospital case managers of decision and schedules admissions after communicating with department managers and obtaining physician approval.
Serves as a contact person for the rehabilitation team, internal admissions team, clients, and external sources to enhance outcomes. Promotes effective public relations with clients and families, healthcare providers, and the community including education programs, tours, meetings, collateral materials.
Develops strategies to grow market share in core business lines by creating quarterly goals and objectives.
Develops and maintains trust and professional credibility as a representative of the Fudge Family Acute Rehabilitation Center.
Other duties as assigned.
Education, Training and Experience
Required: Licensed RN, BSN, MSN, LCSW, PT/OT/SLP, familiar with multiple payers, insurances, and marketing.
Preferred: BSN with at least 2 years of clinical experience, and experience in rehabilitation. Familiar with Medicare admission criteria.
Skills or Other Qualifications
Required: Critical thinking, ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions. Ability to communicate effectively on the patient’s behalf.
Works well 1:1 and in a team to obtain better outcomes.
Possesses a knowledge of the business of healthcare along the continuum of care, clinical decision support data analysis/synthesis, and quality improvement, regulatory and legislative issues.
Self-directed individual with ability to prioritize multiple tasks and meet deadlines, excellent attention to detail, and maintain a high level of work quality.
Proven ability to interface with all customer levels (physicians, organizational staff, insurance companies, patients and family members). Decisive and capable of exercising good judgment under pressure.
Preferred: Qualified bilingual or multilingual candidates. Working knowledge of Microsoft Office Suite, including Outlook, Word, Excel, and PowerPoint, plus healthcare database systems.
Demonstrated expertise in analysis, decision making, time management, oral and written communication, computer use.
Knowledge of resources available for use in assessing regulations and parameters of third party reimbursement.
Excellent assessment skills and knowledge of insurance and managed care principles and practices.
Ability to function independently.
License and Certifications
Required: See above
Preferred: Certification in rehabilitation nursing; FIM certification.
Hoag Memorial Hospital Presbyterian has been the community’s beloved hospital and destination for state-of-the-art sub-specialty medicine. This combination of world-class clinical excellence and close-knit neighborhood care has long distinguished us. When you join Hoag, you become a member of our family. We believe being a member of the Hoag family requires you to give and Hoag is committed to those who work with us to provide patient care.