Bed Planning and Pre-admission Processing:
? Coordinates the placement of rehab admissions in accordance with site specific clinical, regulatory and safety standards
? Maintains a potential admission queue and wait list for inpatient rehabilitation
? Educates patients/family, referral sources, payers and case managers on IRF programming and services, insurance and admission criteria
? Communicates daily with physician consult teams to identify inpatient rehab candidates, projected admission dates and patient prioritization
? Projects occupancy by continuously reviewing scheduled admissions and discharges
? Identifies, reports, and resolves actual and potential admissions delays
? Reviews patient cases and applies clinical knowledge to identify key clinical and regulatory considerations/barriers
? Presents patient case details in multidisciplinary planning huddles to facilitate unit-wide readiness for each patient admission
? Completes chart documentation review and compiles pertinent clinical information required for the pre-admission screening.
Insurance Coordination:
? Evaluates specific clinical information against established CMS and InterQual criteria for completion of preadmission medical necessity reviews
? Initiates insurance prior authorization processes for inpatient rehab stays
? Coordinates peer-to-peer reviews between insurance company medical directors and rehabilitation physicians when necessary
? Facilitates internal physician-to-physician communication and secondary review by Medical Director for any cases in which admittance criteria are in question
? Completes weekly continued stay reviews and re-certifications based on individual insurance requirements
? Maintains thorough and clear documentation of all payer contacts and reviews. Clearly documents all authorizations, actions, contacts, outcomes and interventions to assure appropriate payment of claims
Other Duties:
? Collects, documents, and analyzes a range of data to evaluate referral and admission trends and support program performance optimization
? Monitors, reviews, and queries pre- and post-admission documentation to assure compliance requirements are met
? Participates in the development of standard work, process improvement, and policy and procedure development
? Coordinates facility tours and participates in program marketing