Clinical Assessment Specialist - (RN, PT, OT, SLP)
Select Medical
- Arizona
- Permanent
- Full-time
- Work with Admission Department (and/or acute care hospital personnel) to secure insurance authorization and/or coordination of benefits necessary to be admitted. Develop professional relationships with insurance case managers as appropriate.
- Assess a patient’s eligibility for and feasibility of rehabilitation services in consultation with the field Clinical Liaisons,Senior Clinical Liaison, or Director of Business Development. Review and analyze medical records and history that are key to a determination of suitability for rehabilitative services.
- Prepare and complete a detailed preadmission assessment timely and thoroughly, which meets all regulatory requirements. Documentation will reflect critical thinking and rationale for admission inclusive of medical necessity and projective rehabilitation needs.
- Participate in meetings with hospital leadership, DBD and clinical liaisons to provide market intelligence information and share strategies and results.
- Support team members in the field or in the admissions office as appropriate.
- Assist with insurance authorization backup as needed.
- Obtain timely authorization of all patients requiring pre-certification and are accountable for conversion percentage and results.
- Ensure all policies governing commercial pre-certification and authorization are followed to minimize financial risk.
- Maintain relationship profile by payor for payor case managers and medical directors.
- Identifie by payor their preference or use the best practice coversheet and submission portfolio to the insurance company to maximize results.
- Develop and maintain professional credibility. Gain mutual respect and build confidence with leadership and teammates.
- Perform other related projects and duties as assigned.
- Current and valid state licensure or eligibility for state licensure as a Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Language Pathologist required. Multi-state licensure required based on geographical territory.
- Two years related experience working in a clinical healthcare setting role. Demonstrated competency with the preadmission process including assessments, transitions of care communication, and patient pull-through. Previous experience in a rehabilitation setting or in another post-acute care setting preferred.
- Demonstrated computer proficiency.
- Must exercise sound judgment in handling professional/confidential nature of health care information.
- Brain Injury
- Spinal Cord Injury
- Stroke
- Amputation
- Neurological Disorders
- Orthopedic Conditions
- Multiple Traumas