Responsible for evaluating rehab referrals for appropriateness of admission based on CMS’ Inpatient Rehab Facility (IRF) Guidelines . Required to complete pre-admission assessment on all patients admitted to the DCH Rehabilitation Pavilion. Completes insurance pre-certification on all patients being admitted with commercial insurance.
Insures proper utilization of resources by recommending proper level of post-acute care on all referred patients. Functions in rehab team leadership role by identifying patients needs to justify rehab admission. Coordinates flow of information between patient, families, rehab team, physicians, and payers.
Responsibilities In screening referred patients, summarizes acute care hospital course, including pertinent diagnostics, procedures, lab results, imaging studies, and therapy status. Uses this information to identify patient’s medical, nursing, and functional needs. Uses clinical judgment and rehab physician input, if needed, to provide guidance to acute care team regarding medical, nursing and functional interventions needed for patient to qualify for rehab admission.
In screening referred patients, comprehensively assesses patient’s prior functional status, home situation, rehabilitation needs, ability to participate, expectations for functional improvement, and discharge plan. Assessment findings are reported to person(s) responsible for making admission/denial decisions (Medical Director and/or Rehab Services Director). In screening referred patients, determines compliance with CMS’ IRF criteria including need for medical supervision, intense level of therapy services, multidisciplinary approach, coordinated care plan and reasonable expectation for, significant practical improvement.
Completes a comprehensive pre-admission assessment form, which is used to justify rehab admissions. Pre-certifies all patients with commercial insurance by providing a detailed case summary along with the comprehensive pre-admission assessment to the insurance case manager. Responsible to make every effort possible to meet admission/census goals for the DCH Rehabilitation Pavilion.
Documents patient’s rehab acceptance/denial as well as reasons in medical record. Clearly documents reasons for rehab admission on pre-admission assessment form to justify admission and to begin team treatment planning process. Provides guidance to acute care case managers to insure patients are being referred and accepted at the appropriate post-acute level of care.
Must be knowledgeable of CMS (Medicare) Rehab policies and guidelines for inpatient rehabilitation facilities and be able to apply these guidelines to individual cases. Educates referral sources on inpatient rehabilitation facility guidelines. Understanding of insurance coverage guidelines for IRF’s, SNF’s, LTACH’s, HH, and OP and ability to explain same to patients, families, case managers, and physicians.
Ability to access, verify, and understand individual policy coverage and limitations such as covered and non-covered services, covered days, co-pays, lifetime reserve days and ability to explain same to patients, families, case managers, and physicians. Negotiates acceptable rehabilitation coverage rates with insurance providers when indicated. Education and marketing of referring Case Managers, Nurse Managers and Physicians.
Coordinates responsibilities with other Admissions/Care Coordinators. Rotates weekend coverage with other Admissions/Care Coordinators, as assigned. Assists in patient education activities.
Conducts in-service classes in hospital and community when requested. Markets to outside facilities as requested. Maintains required records and reports.
Maintain personal automobile liability insurance, and remain insurable to the standards that are established by DCH’s insurer as they may exist at any time. DCH Standards: Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation. Performs compliance requirements as outlined in the Employee Handbook Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
Performs essential job functions in a manner that ensures the safety of patients, visitors and employees. Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees. Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.
Requires use of electronic mail, time and attendance software, learning management software and intranet. Must adhere to all DCH Health System policies and procedures. All other duties as assigned.
Qualifications Currently licensed Registered Nurse in the State of Alabama (BSN preferred), Physical Therapist,Occupational Therapist, Speech Language Pathologist, Certified Occupational Therapy Assistant, or Licensed Physical Therapy Assistant 2 years of Inpatient Rehabilitation experience preferred. Must have excellent communication and interpersonal skills Previous experience in case management preferred Previous experience with PR/Marketing preferred Must be able to read, write legibly, speak and comprehend English BLS Certification required Working Conditions WORK CONTEXT Must be able to analyze patient data to determine patient needs or treatment goals Must be able to enter patient or treatment data into computers Must be able to collaborate with others to plan or provide treatment Must have normal vision and hearing or correctable to normal Must be careful about detail and thorough in completing work tasks.
Must be reliable, responsible, dependable, and fulfilling obligations. Must be pleasant with others on the job and display good nature, cooperative attitude. Must be able to tolerate prolonged periods of sitting and/or standing Must be able to exert almost continual physical effort such as pushing, pulling, bending, climbing, lifting, and walking.
Exposure to human bodily fluids, disease, infection and hazardous materials may occur. Common protective or safety equipment may be required in job task. PHYSICAL FACTORS Physical activities include: talking, hearing, bending, twisting, walking, running, kneeling, crouching, stooping, crawling, climbing, balancing, reaching, pushing, pulling, lifting, grasping, repetitive motion, standing, and/or using hands to handle, control, or feel objects, tools or controls).
Sedentary work. Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.
Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met. Must be able to perform the duties with or without reasonable accommodation. Hearing and vision must be normal or corrected to within normal range.
Physical presence onsite is essential.