Clinical Liaison Specialist
4 weeks ago
The Clinical Liaison Specialist will serve as a liaison between managed care organizations and our facility's professional clinical staff. This role requires strong communication and coordination skills to ensure seamless interactions between parties.
Key Responsibilities
• Conduct reviews of insurance plans and MCOs to ensure compliance with certification requirements.
• Coordinate communication with clinical and medical staff regarding reimbursement requirements and patient length of stay.
• Monitor patient length of stay and extensions, and inform staff of potential issues affecting length of stay.
• Gather and develop statistical and narrative information to report on utilization, non-certified days, discharges, and quality of services.
• Conduct quality reviews for medical necessity and services provided.
• Facilitate peer review calls between facility and external organizations.
• Initiate and complete the formal appeal process for denied admissions or continued stay.
• Assist the admissions department with pre-certifications of care.
• Provide ongoing support and training for staff on documentation, charting requirements, continued stay criteria, and medical necessity updates.
Requirements
• LPC or LSW in behavioral or mental health or other related health field.
• Two or more years' experience with the population of the facility and previous experience in utilization management preferred.
• Current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
• CPR and de-escalation and restraint certification required (training available upon hire and offered by facility).
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