Rehab Admissions Coordinator - Full Time - Day Shift - Wyandotte Hospital

• Utilizing clinical screening guidelines and insurance criteria; assess patient status to determine appropriateness of admission. Perform multi-facility on-site patient assessment of medical, psycho-social and functional status.
• Perform pre-certification with insurance company and communicate authorization/denial to internal referrals sources, case managers, external referral source, case managers and internal/external physicians.
• Recommend and communicate alternate level of care to internal and external physicians, case managers, patients, family, and third party payers. Facilitates arrangement for placement in appropriate facility.
• Act as primary contact for all admissions to the rehab unit regardless of point of entry, including internal and external sources and facilities.
• Determine benefits and eligibility for admission, SNF, and DME coverage by performing insurance verification. Negotiate insurance payment rates with third party payers as needed.
• Prioritize and assign beds for internal and external patients awaiting admission. Proactively assign and reserve appropriate beds for pending complex cases.
• Round with acute care case managers, therapists and physicians to identify potential rehab candidates. Screen and facilitate patient transfer and placement.
• Communicate with nursing and social work staff to determine patient discharge day and time to prevent OR and ED admissions back up.
• Perform daily contact with Rehab Physicians, internal and external primary and consulting physicians. Discuss patient's current functional and medical status, verify acceptable Rehab diagnosis and criteria for admission, and determine need for followup orders.
• Meet with patient and family prior to admission, conduct Rehab Unit tours, discuss post Rehab discharge plan, required functional level needed upon discharge, projected length of stay and insurance issues, discharge disposition options, and communicate pertinent patient information to Rehab team members. Provide education to patients and families regarding resource options, coping with diagnosis, treatment options and prognosis.
• Identify, report, and resolve actual and potential delays in service and inappropriate use of resources.
• Participate in the development of plan of care including discharge plan, with multidisciplinary health care team, patient, and family.
• Coordinates and/or participates in multidisciplinary patient and family meetings.
• Provides consultation to other case management and social work staff on complex cases.
• Identify and refer potential quality concerns to Quality Assessment/Risk Management/Legal Affairs.
• Perform insurance re-certification and communicate continued stay and authorization to physicians, treatment team and HFHS Billing. Perform concurrent chart review following admission to assess functional status and recommend continued stay vs. alternate level of care.
• Address billing and reimbursement concerns with patient and family, HFHS Billing Office and third party payer representatives. Perform retrospective insurance appeal for authorization of pay.
• Act as corporate level representative for HFHS Rehab Program and participate in System Rehab Management Meetings.
• Perform marketing and promotion of HFHS Rehab Program, including case finding, facility tours, conference exhibits, referral source and third party payer relations development, outcome data reports in the state of Michigan/our geographic region.
• Collect, document, and tabulate statistical data regarding numbers of referrals, admissions, rejections, and reasons for rejections, for CARF and Rehab Program Administration analysis.
• Provide ongoing liaison between Service Line Administrator, Medical Director, Therapy Manager, Nurse Manager, treatment team, third party payers,
• referral sources, the patients and their families
• Provide all above services and trouble-shooting after hours and weekends on an as needed basis, via pager and home telephone contact.

EXPERIENCE/EDUCATION REQUIRED:

• Must be currently Licensed in the State of Michigan as a Registered Nurse (RN), Physical Therapist (PT), Occupational Therapist (OT) or Speech & Language Pathologist (SLP)
• BSN preferred, CRRN preferred
• Two years of progressively more responsible experience in the rehabilitation field is required.
• Case management experience preferred.
• Experience in the rehabilitation of chronically/catastrophically ill or injured individuals is highly preferred.
• Understand regulations and parameters of third party reimbursement necessary.
• Demonstrate excellent skills in oral and written communication, decision making, accountability, analysis, and time management.
• Participate in continuing education appropriate to rehabilitation case management.
• Mental ability to make judgments on appropriate placement of patients based on available clerical data

• Organization: Henry Ford Wyandotte Hospital
• Department: Physical Medicine-WH
• Shift: Day Job
• Union Code: Not Applicable