Pre-Admission Referral Coordinator

POSITION SUMMARY :

Under the direct supervision of the Manager, Care Coordination - the Pre-Admission Referral Coordinator directs clinical and financial pre-admission screenings and facilitates optimal resource utilization across Nexus Health Systems in effort to promote patient access, quality care, and meet placement objectives. The Pre-Admission Referral Coordinator works collaboratively with clinical and non-clinical departments such as, but not limited to, Admissions, Utilization Review, Central Business Office and other operational teams as needed - to meet organizational objectives.

JOB-SPECIFIC RESPONSIBILITIES :

• Maintain utmost level of confidentiality at all times
• Adhere to health system policies and procedures
• Responsible for promoting adherence to applicable State / Federal laws and regulation and the program requirements of accreditation agencies and Federal / state private health plans in requests for third party reimbursement
• Provides support for team of Care Coordinators and other internal team members as applicable to job specifics.
• Coordinates the Pre-Admission referral evaluation process.
• Evaluates incoming referrals and identifies appropriate programming based upon clinical presentation and program guidelines.
• Reviews Pre- Admission referral form, clinical, and other attachments as needed, as part of the evaluation process.
• Completes a criteria review with an abbreviated clinical summary with each Pre- Admission referral.
• Collaborates / Communicates with internal / external partners for additional information as needed in effort to complete the criteria review process / expedite the Pre-Admission Review.
• Prioritizes Clinical Summary assignments to Care Coordinators based upon clinical presentation, program specifics, and staffing.
• Facilitates movement of the referral throughout the Pre-Admission referral process as appropriate in a time sensitive manner in effort to minimize delay and expedite patient placement decisions.
• Provides follow-up on missing information within 48 hours from the date of receipt or sooner as appropriate, in effort to expedite the referral review process.
• Maintains referral correspondence, written and verbal, within a centralized referral database.
• Exemplifies excellent customer service while communicating internally / externally with stakeholders, to obtain necessary documentation.
• Participates in departmental meetings as appropriate to departmental policy.
• Provides support to on-going quality initiatives in conjunction with departmental policy.
• Escalates referral questions / concerns to supervisor as needed in effort to promptly resolve, minimizing process disruptions.
• Adheres to departmental productivity / process requirements as specific to role.
• Other duties, as assigned.

POSITION QUALIFICATIONS :

EDUCATION :

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LICENSURE / CERTIFICATION :