Clinical Liaison Nurse

Facility: Wellstar MCG Health Warm Springs, Inc.

Job Summary

The Clinical Liaison is a member of the care coordination department and is responsible for participating in the referral coordination for local hospitals. He/she functions as a marketing representative for clinical referrals. He/she interacts with the case managers, admission coordinator, and other liaisons on site. He/she regularly reviews the clinical chart of potential long-term acute care patients and begins the admissions process with the help of the admissions coordinator. In addition the clinical liaison uses InterQual, NALTH criteria to assess patients. He/she will function as a sales, marketing, and clinical specialist for the hospital. Role requires basic understanding of Medicare, Medicaid, and private insurance.

Core Responsibilities and Essential Functions

Conducts a review of data to determine admission eligibility and an individual’s health care needs or needs for services.

• Reviews information from referring facilities.

• Reviews screening assessment for necessity and appropriateness of health services by the application of established screening criteria (i.e. NALTH, InterQual, etc…)

• Timely identification and referral for alternative level of care.

• Completes and coordinates paperwork as required by post-discharge providers.

Identifies potential care needs based on assessment.

• Assesses insurance and coverage issues such as managed care, PPO, HMO, and the identification of preferred providers.

• Identifies issues relating to patient type and/or appropriateness of admission and/or continued stay and collaborates with physician/physician advisor for resolution.

Monitor for compliance of Medicare/Medicaid regulations (i.e. order for patient type of billing, appropriate billing, etc…).

• Review insurance of potential patients and discuss validity and discharge plan with patient/family.

• Assess various forms of insurance for in-network vs. out-of-network benefits.

• Begin the precertification process: calling insurance companies for authorizations and checking Medicare days.

Required Minimum Education:

• Accredited Program Nursing

• Accredited Program Respiratory Therapy

• Associates Accounting

• or Bachelors Nursing-Preferred

Required Minimum Experience

• Minimum 2 years of clinical experience directly related to ICU/IMCU patients in acute setting Preferred

• Less than 1 year LTAC or previous liaison experience Preferred

Required Minimum Skills

• Must have excellent communication skills, able to handle incoming and outgoing calls, visitors, and other customers in a professional and courteous manner.

• Must be organized and capable of handling multiple tasks at once.

• Demonstrates ability to interview patients, staff and visitors with effective written and/or verbal communication skills.

• Knowledgeable of screening criteria in review of clinical data with respect to patients/client’s needs for healthcare.

• Ability to effect change performs critical analysis, promote client/family autonomy and plan and organize effectively for the continuum of care.

• Have knowledge of funding resources, community resources, services and clinical standards and outcomes.

Required Minimum License(s) and Certification(s) Upon Hire

• Respiratory Care Prof Upon Hire Required

• Reg Nurse (Single State) Required

• RN - Multi-state Compact Required