Job 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)

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.