Clinical Navigator

6 days ago

Wausau, Wisconsin, United States PAM Health Full time

About the Role

The Clinical Navigator will work under the direction of the Director of Business Development to cultivate referral relationships, manage assigned territory, and complete patient assessments. This position will make sales contacts as well as analyze referral and admission data from assigned territory.

Key Responsibilities

Pre-Admission Assessment

• Maintain responsibility for patient referral until patient admits to Post Acute Medical.

• Display knowledge of both inpatient rehabilitation and long-term acute care (LTACH) admissions criteria for pre-assessment analysis.

• Coordinate and complete on-site pre-admission assessments on potential patients unless geographically prohibitive or competitive time of admission will not allow.

• Complete phone/FAX assessments if geographically prohibitive.

• Document pre-admission assessments legibly, accurately, and completely in the approved format.

• Review medical record of referred patient and identify all aspects related to pre-certification financial coverage and admission criteria.

• Serve as a navigator to the Admissions office for insurance companies and provide clinical information to obtain pre-certification from payers.

• After reviewing medical record and interviewing patient/family, obtain facility admission information to support the admission process; make a recommendation regarding acceptance and level of care, and communicate status of admission to referral source as directed by the admissions department.

• Orient patient and/or family to facility services, including length of stay.

• Educate supports and serves as a resource to family members of current, past and potential patients.

• Communicate with facility Admissions department and facility CEO on a daily basis to optimize census management and case finding strategies.

• Follow up on all pending as well as medical denials in person to re-evaluate potential for admission.

• Conduct follow up with referral facilities to ensure satisfaction and service levels were met.

Business Development

• Design and manage the marketing strategies for their assigned territory.

• Use sales and marketing techniques to show growth in admission and revenue volume.

• Create Quarterly Business Development Plan for their assigned territory.

• Utilize educational opportunities to present the hospital to referral sources.

• Identify contacts and manage potential referral sources using account management system.

• Use prospecting methods to generate leads.

• Meet the referral and admission goals for their assigned territories.

• Participate in community events/activities.

• Attend weekly Business Development meetings.

Education

• Identify and educate new referral sources to Post Acute Medical programs and services.

• Assess and convey stakeholder needs.

• Establish and maintain strong relationships with providers through ongoing assessment and servicing of their client's rehabilitation/LTACH needs.

• Schedule educational inservices to educate referral services about Post Acute Medical programs and services; work closely with the Admissions department and Director of Business Development to achieve targeted census goals and meet assigned objectives on a weekly, monthly and quarterly basis.

• Communicate clearly, concisely and accurately.

• Provide or arrange educational presentations to referral sources (physicians, discharge planners), families and to community members as requested.

• Coordinate and schedule professional, family and/or potential patient tours of all facilities.

• Gather information on health care providers in the facility service area and forward to management, including opportunities for contracting with managed care companies and providers.

• Assist in the development of new programs and services through ongoing assessment of the needs of professionals, families, and patients.

• Remain current on new programs and services in the Post Acute Medical System through frequent communication and facility visits.

Documentation Reporting

• Effectively maintain log of all pending cases.

• Provide periodic verbal/telephone/email update on activities and market trends as requested.

• Maintain a resource library of articles and information for distribution to professionals, community members, families and potential patients to assist them in understanding facility services and the various disability groups served.

• Complete a quarterly plan for assigned territory.

• Maintain 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.

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 presentation and 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.

• Network access to community, state, and national resources and health services organizations.

• Excellent relationship management skills with referral sources and physicians.

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