Clinical Admissions Specialist
2 weeks ago
Overview:
PURPOSE STATEMENT:
The Clinical Admissions Specialist plays a vital role in managing the admissions process, conducting clinical intake evaluations, and overseeing utilization review procedures to ensure patients receive the most suitable level of care while optimizing their benefits and resources.
Responsibilities:
ESSENTIAL FUNCTIONS:
Respond to inquiries regarding the facility in accordance with established policies.
Establish therapeutic relationships with patients and their families.
Verify benefit eligibility to confirm that patient benefits are active at the time of admission and communicate this information to the business office and the patient or their significant other.
Collaborate with medical and psychiatric staff to ensure appropriate recommendations for pending referrals.
Coordinate admissions and transfers from referral sources and between different levels of care within the facility.
Maintain a comprehensive understanding of milieu management.
Promptly communicate projected admissions to designated internal representatives.
Ensure all clinical information from referral sources or patients (including medical comorbidity details) is obtained, when feasible, prior to patient admission.
Schedule and conduct pre-admission assessments, consult with the admitting physician, and relay disposition recommendations to the patient or their family.
Demonstrate proficiency in preparing and maintaining accurate medical record documentation to secure authorization for the requested level of care from payors.
Complete initial pre-authorization for treatment and admission prior to admission, when feasible, and within payor timeframe guidelines.
Register patients in the accounting system and complete all necessary admission and consent forms with the patient.
Exhibit a positive, empathetic, and professional demeanor towards customers at all times. When patient needs are unmet, acknowledge and work towards resolving complaints. Recognize that patient safety is of utmost importance.
OTHER FUNCTIONS:
Perform additional functions and tasks as assigned.
Qualifications:
EDUCATION/EXPERIENCE/
SKILL REQUIREMENTS:
A Bachelor's degree in a social services field is required (if permitted by state regulations).
A Master's degree in a social services field (psychology, counseling, social work, sociology, health administration, nursing) or RN is preferred.
A minimum of three years of experience in mental/behavioral health working with individuals in a clinical or observational capacity is preferred.
Experience with managed care pre-certification processes, level of care assessments, and utilization is preferred.
LICENSES/DESIGNATIONS/
CERTIFICATIONS:
Current licensure, as required for the area of clinical specialty, such as a current RN license, CAC, or other clinical counseling or therapy license, as designated by state regulations.
CPR and de-escalation/restraint certification are required (training available upon hire and offered by the facility).
First aid certification may be required based on state or facility regulations.
We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal, and local laws.
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