Post-Acute Care Clinical Specialist
2 weeks ago
The Post-Acute Care Clinical Specialist is responsible for overseeing the entry point into post-acute services, which entails assessing all patients for medical suitability and necessity.
This role involves engaging with and educating patients, families, case managers, payers, and healthcare providers.
Key Responsibilities:
- Manage and process referrals for post-acute services, ensuring verification of benefits either directly or by liaising with the intake office.
- Conduct comprehensive admission assessments to determine the appropriateness of care.
- Collaborate closely with medical directors and physicians to enhance marketing efforts and optimize patient census through community evaluations.
- Ensure thorough pre-admission screenings are documented and that all necessary documentation is collected in compliance with regulatory standards.
Qualifications:
- Graduation from an accredited program in Respiratory Care, Occupational Therapy, Physical Therapy, or Nursing.
- Possession of a valid Oklahoma Provisional Respiratory Care Practitioner License or equivalent credentials.
- Minimum of three years of relevant experience in a healthcare setting.
Skills and Competencies:
- In-depth knowledge of post-acute services and third-party payer reimbursement processes.
- Proficient in Microsoft Office Suite, particularly Word and Excel.
- Strong attention to detail and excellent interpersonal skills.
- Ability to navigate complex situations involving patients, physicians, and insurance representatives.
Essential Functions:
- Utilize clinical knowledge to perform assessments and determine admission appropriateness.
- Verify patient insurance benefits as part of the pre-admission process.
- Work collaboratively with funding sources to maximize patient benefits.
- Act as a resource for case management regarding post-acute service needs.
- Process referrals promptly and communicate determinations to referral sources.
- Participate in various meetings to ensure continuity of care and effective communication among team members.
- Engage in external marketing efforts to promote the program and maintain targeted growth.
- Monitor admissions and denials to identify trends and opportunities for development.
Decision-Making:
Exercise independent judgment in making decisions within established policies and protocols.
Collaboration:
Coordinate activities with other healthcare professionals and work directly with patients and customers.
Additional Information:
This overview outlines the essential functions and physical demands of the role, which may evolve over time.
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