Clinical Navigator

PAM Health
Published
June 23, 2022
Location
United States
Category
Other  
Job Type
Work Setting
In-office

Description

This position works under the direction of the Director of Business Development. Cultivates referral relationships manage assigned territory, and completes patient assessments. Makes sales contacts as well as analysis of referral and admission data from assigned territory. Works collaboratively with business development team members including the Admissions Manager and admission staff, as well as nursing and other internal and external staff to facilitate the referral conversion. Provides feedback and recommendations for program development and quality improvement initiatives related to customer service, the referral and admission process, and patient and referral source satisfaction. Develops and maintains excellent relationships with all stakeholders including prospective patients, family members, physicians, ICU and floor nurses, discharge planners, case managers, and payer representatives. Performs other related duties as assigned or requested.

Responsibilities

Pre-Admission Assessment

• Maintains responsibility for patient referral until patient admits to Post Acute Medical.
• Displays knowledge of both inpatient rehabilitation and long-term acute care (LTACH) admissions criteria for pre-assessment analysis.
• Coordinates and completes on-site pre-admission assessments on potential patients unless geographically prohibitive or competitive time of admission will not allow. The assigned market uses the fast-track process to facilitate referral conversions. Completes phone/FAX assessments if geographically prohibitive. Documents pre-admission assessments legibly, accurately, and completely in the approved format.
• Reviews medical records of referred patients and identifies all aspects related to pre-certification financial coverage and admission criteria. Serves as a navigator to the Admissions office for insurance companies and provides clinical information to obtain pre-certification from payers.
• After reviewing the medical record and interviewing patient/family, obtains facility admission information to support the admission process; makes a recommendation regarding acceptance and level of care, and communicates status of admission to referral source as directed by the admissions department.
• Orients patient and/or family to facility services, including length of stay. Educates supports and serves as a resource to family members of current, past, and potential patients.
• Communicates with the facility Admissions department and facility CEO on a daily basis to optimize census management and case-finding strategies.
• Follows up on all pending as well as medical denials in-person to re-evaluate potential for admission.
• Conducts follow-up with referral facilities to ensure satisfaction and service levels were met.

Business Development

• Designs and manages the marketing strategies for their assigned territory.
• Uses sales and marketing techniques to show growth in admission and revenue volume.
• Creates Quarterly Business Development Plan for their assigned territory.
• Utilizes educational opportunities to present the hospital to referral sources.
• Identifies contacts and manages potential referral sources using account management system.
• Uses prospecting methods to generate leads.
• Meet the referral and admission goals for their assigned territories.
• Participates in community events/activities.
• Attends weekly Business Development meetings.

Education

• Identifies and educates new referral sources to Post Acute Medical programs and services.
• Assesses and conveys stakeholder needs. Establishes and maintains strong relationships with providers through ongoing assessment and servicing of their client’s rehabilitation/LTACH needs.
• Schedules educational in-services to educate referral services about Post Acute Medical programs and services; works 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. Communicates clearly, concisely, and accurately.
• Provides or arranges educational presentations to referral sources (physicians, discharge planners), families, and to community members as requested.
• Coordinates and schedules professional, family, and/or potential patient tours of all facilities.
• Gathers information on health care providers in the facility service area and forwards it to management, including opportunities for contracting with managed care companies and providers.
• Assists in the development of new programs and services through ongoing assessment of the needs of professionals, families, and patients.
• Remains current on new programs and services in the Post Acute Medical System through frequent communication and facility visits.

Documentation Reporting

• Effectively maintains a log of all pending cases.
• Provides periodic verbal/telephone/email updates on activities and market trends as requested.
• Maintains 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.
• Completes a quarterly plan for assigned territory.
• Maintains 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. Prior marketing and/or rehabilitation/LTACH experience preferred.

Experience

Must have a minimum of two years of experience in the designated field of a 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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