Clinical Liaison RN at 5000 Wellstar Medical Group, LLC

, , United States -

Full Time

Start Date

Immediate

Expiry Date

25 Jul, 26

Salary

0.0

Posted On

26 Apr, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical assessment, Care coordination, Referral management, Insurance verification, Medicare compliance, Medicaid regulations, InterQual, NALTH criteria, Patient interviewing, Communication skills, Critical analysis, Discharge planning, Precertification, Data review, Time management

Industry

Hospitals and Health Care

Description

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 Various (United States of America) Job Summary: The Clinical Liaison is a member of the care coordination department and is responsible for participating in the referral coordination for local hospitals. He/she functions as a marketing representative for clinical referrals. He/she interacts with the case managers, admission coordinator, and other liaisons on site. He/she 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. He/she will function as a sales, marketing, and clinical specialist for the hospital. Role requires basic understanding of Medicare, Medicaid, and private insurance. Core Responsibilities and Essential Functions: Conducts a review of data to determine admission eligibility and an individuals 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. Performs other duties as assigned Complies with all Wellstar Health System policies, standards of work, and code of conduct. Required Minimum Education: Associates Nursing Required Bachelors Nursing-Preferred Required Minimum License(s) and Certification(s): All certifications are required upon hire unless otherwise stated. RN - Reg Nurse (Single State) or RN-COMPACT - RN - Multi-state Compact BLS - Basic Life Support from the American Red Cross or American Heart Association Required Minimum Experience: Minimum 2 years of clinical experience directly related to ICU/IMCU patients in acute setting Preferred Minimum 1 year 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/clients 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. Nationally ranked and locally recognized for our high-quality care and inclusive culture, Wellstar is one of Georgia’s largest and most integrated healthcare systems. Every day, 24,000+ of us work together to provide personalized care for patients at every age and stage of life – and our team members are the foundation of that care. Mission, Vision & Values At a time when the healthcare industry is changing rapidly, Wellstar remains committed to exceeding patients’ and team members’ expectations, while transforming healthcare delivery. OUR MISSION: To enhance the health and well-being of every person we serve. OUR VISION: Deliver world-class healthcare to every person, every time. OUR VALUES: We serve with compassion We pursue excellence We honor every voice Culture of Excellence Wellstar consistently receives attention and accolades from national organizations that set the standards for world-class care. Our system-wide practice of safety principles, assessing and addressing errors and seeking feedback from our patients and customers continually earns recognition for advances in safety and quality. Featured on the FORTUNE “100 Best Companies to Work For” list and Seramount 100 Best Companies list, we not only provide top-notch care for our patients, but also foster the culture of Wellstar as a Great Place to Work.

Responsibilities

The Clinical Liaison is responsible for coordinating patient referrals, reviewing clinical charts for admission eligibility, and assessing patient needs against established criteria. They also act as a marketing representative and clinical specialist, managing insurance authorizations and collaborating with healthcare teams to ensure appropriate care transitions.