Clinical Navigator

4 weeks ago

Sugar Land, United States PAM Health Full time

**Clinical Navigator Evaluator**

This position works under the direction of the Director of Strategic Initiatives and Integration. Completes patient pre-admission assessments, pre-admission assessment updates and works collaboratively with business development team members including the Admissions Manager and admission staff, as well as nursing and other internal and external staff to facilitate the referral conversion. Performs other related duties as assigned or requested.

**RESPONSIBILITIES**

**Pre-Admission Assessment**
- Maintains responsibility for patient referral until patient admits to PAM Health.
- Displays knowledge of both inpatient rehabilitation and long-term acute care (LTACH) admissions criteria for pre-assessment analysis.
- Coordinates and completes on-site pre-admission assessments on potential patients unless geographically prohibitive or competitive time of admission will not allow. In the assigned market uses the fast track process to facilitate referral conversions. Completes phone/FAX assessments if geographically prohibitive. Documents pre-admission assessments legibly, accurately, and completely in the approved format.
- Reviews medical record of referred patient and identifies all aspects related to pre-certification financial coverage and admission criteria. Serves as a navigator to the Admissions office for insurance companies and provides clinical information to obtain pre-certification from payers.
- After reviewing medical record and interviewing patient/family, obtains facility admission information to support the admission process; makes recommendation regarding acceptance and level of care, and communicates status of admission to referral source as directed by the admissions department.
- Orients patient and/or family to facility services, including length of stay. Educates supports and serves as a resource to family members of current, past and potential patients.
- Communicates with facility Admissions department and facility CEO on a daily basis to optimize census management and case finding strategies.
- Follows up on all pending as well as medical denials in person to re-evaluate potential for admission.
- Conducts follow up with referral facilities to ensure satisfaction and service levels were met.
- Attends weekly Business Development meetings.

**Education**
- Remains current on new programs and services in the PAM Health System through frequent communication and facility visits.

***Documentation Reporting**
- Effectively maintains log of all pending cases.
- Maintains territory Account Management System.

**QUALIFICATIONS**

**Education and Training**:Degree from an accredited college or university in a health field, preferably nursing. Current licensure in nursing or respiratory therapy is preferred. Prior rehabilitation/LTACH experience preferred.

**Experience**:Must have a minimum of two years’ experience in the designated field of license, preferably with rehabilitation/LTACH and marketing experience.

**Knowledge, Skills, and Abilities**:

- Excellent clinical and assessment skills.
- Effective training skills.
- Excellent written and oral communication skills.
- Effective crisis management skills, with demonstrated facilitation and problem solving experience.
- Effective team leadership skills.
- Knowledge of PPS payment/reimbursement systems and DRG’s/case weights.
- Knowledge of patient rights and commitment to patient advocacy.
- Ability to collect, document, and analyze data.
- Word processing and data entry skills.
- Excellent relationship management skills with referral sources and physicians.

**ABOUT US**

**PAM HEALTH **(PAM) based in Enola, Pennsylvania, provides specialty healthcare services through more than 70 long-term acute care hospitals and physical medicine and rehabilitation hospitals, as well as wound clinics and outpatient physical therapy locations, in 17 states. PAM Health is committed to providing high-quality patient care and outstanding customer service, coupled with the loyalty and dedication of highly trained staff, to be the most trusted source for post-acute services in every community it serves. Its mission is to serve people by providing compassionate, expert care, and to support recovery through education and research.

Joining our PAMily allows you to work in a collaborative environment with colleagues and leadership with exposure to a variety of patient care levels. Aside from our competitive pay, generous paid benefit time, and excellent insurance options, you will also have opportunities for professional growth through our Education Advancement Program.

**_ PAM Health_**_ does not discriminate and does not permit discrimination, including, without limitation, bullying, abuse or harassment, on the basis of actual or perceived race, color, religion, national origin, ancestry, age, gender, physical or mental disability, sexual orientation, gender identity or expression or HIV status, or based on association with a

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