About the role
Day Works collaboratively with all members of the health care team and the patient/family to ensure prompt and efficient intake and admissions for all patients referred to OLOL Rehabilitation Center. The Rehab Liaison conducts patient assessments that include physical and psychological factors in order to plan for individualized continuum of care needs and that meet regulatory criteria under the IRF-PPS. Evaluation and Collaboration Evaluates potential rehab candidates referred to OLOL Rehabilitation Center and functions as a liaison between OLOL and referral sources.
Pre-admission assessments are conducted under the criteria and guidelines of CMSs IRF-PPS to ensure appropriateness of admission and to determine medical necessity. Works with healthcare team to develop rehab treatment/discharge plan. Conducts weekly Admissions Committee meetings with Medical Director to determine appropriate admissions and communicates information to nursing team.
Maintains archives of denied patient assessments for the required period. Develops, builds, and maintains professional relationships with current or potential referral sources. Understands the capabilities of outside referral sources (such as home health, skilled nursing, etc) and the requirements for prior approval by payors for admission, continued stay, and discharge.
Contributes to community and professional education. Assists with marketing efforts and customer satisfaction to ensure continuation and/or expansion of referral base. Participates in SPIRIT classes as requested to explain inpatient rehab, the referral process, rehab qualifications and expectations.
Obtains timely pre-certification and insurance verifications from third-party payors to support effective reimbursement for admissions. Uses 3M and RUMBA programs to verify and document insurance information. Serves as liaison with HCR office for Medicaid applicants.
Communicates with business office when insurance changes occur. Communicates insurance/payor information to patients and families. Understands IRF-PPS regulatory criteria and how to access resource information from CMS, MACs, etc. in order to maintain optimum reimbursement for the unit.
Initiates and completes the IRF-PAI. Demonstrates ability to maximize financial outcomes with effective coding of the IRF-PAI. Collaborates with HIM and physicians to ensure appropriate capture of coding that supports medical necessity criteria.
Communicates CMG information to the interdisciplinary team in order to facilitate care planning. Communicates approval status with referral sources, patients and families in a timely and effective manner. Interacts with team members to facilitate alternate placement in the event of denial or inability to admit to OLOL Rehabilitation Center.
Communicates information with patients and families about the rehab physician, expectations of the inpatient program, discharge planning, family training, and team conferences. Provides tours of the unit upon request. Demonstrates ability to access and utilize community resources.
Is knowledgeable of ADA and other federal guidelines that support individuals with disabilities. Appropriately refers patients/families to community resources for additional support. Other duties as assigned Other duties as assigned Experience - Three years in general or specialty practice Education - Associate's Degree Licensure - Current Unrestricted Louisiana RN license (if nurse), Current Unrestricted Louisiana LPN license or Current Louisiana Therapy license (if PT/OT/ST, certification also required if ST) or Licensed Physical Therapy Assistant