Clinical Pre-Assessment Review Specialist

Overview

The Clinical Pre Assessment Review Specialist works under the direction of the Executive Vice President of Business Development and is responsible for conducting and completing comprehensive reviews of clinical documentation as it relates to the preadmission screen (PAS), prior to admission. This role evaluates thoroughness and accuracy of clinical documentation and identifying opportunities for improved documentation in the preadmission screen (PAS). The specialist provides education and real-time feedback to Clinical and Physician Navigators (CN/PN) and Directors of Strategic Initiatives and Integration (DSI).

 

 

Candidates must be able to work either 11am-7pm or 8am-5pm CST

Responsibilities

I. Position Responsibilities

· Displays knowledge of both inpatient rehabilitation and long-term acute care (LTACH) admissions criteria for pre-assessment analysis.

· Review patient medical records and utilize clinical and regulatory knowledge and skills, as well as, knowledge of payer requirements to ensure preadmission screens (PAS) contain all the required elements of documentation.

· Completes real time edits to the preadmission screen (PAS) to ensure it contains all necessary and required elements of documentation.

· Utilize pre-existing criteria and other resources and clinical evidence to develop sound preadmission screens (PAS).

· Apply evidence-based guidelines to determine medical necessity.

· Communicate preadmission screening (PAS) recommendations effectively.

· Educates, supports and serves as a resource to Clinical and Physician Navigators (CN/PN) and Director of Strategic Initiatives and Integration (DSI).

· Communicates with facility Admissions department and facility CEO on a daily basis to optimize census management and case finding strategies.

· Demonstrates excellent written communication. Writes clearly and informatively; edits work for spelling and grammar; varies writing style to meet needs; presents numerical data effectively; able to read and interpret written information.

· Other duties as assigned.

 

Documentation Reporting

· Effectively maintains log of all pending cases and weekly productivity report.

· Excellent communication and collaborative skills.

· Timeliness of reviews and decisions.

· Provides daily verbal/telephone/email updates on all pending patients.

· Maintains territory Account Management System.

 

II. Leadership

· Inclusiveness: Promotes cooperation, fairness and equity; shows respect for people and their differences; works to understand perspectives of others; demonstrates empathy; brings out the best in others and in his/her team

· Managing Staff: Coaches, evaluates, develops, and inspires staff; sets expectations; recognizes achievements

· Stewardship and Resource Management: Demonstrates accountability and sound judgment in managing company resources; appropriate understanding of confidentiality and company values; adheres to and supports company policies, procedures and safety guidelines

· Problem-Solving: Identifies problems and involves others in seeking solutions; conducts appropriate analysis and searches for best solutions; effectively and efficiently implements appropriate responses to correct problems; responds promptly and effectively to new challenges

· Decision-Making: Makes clear, consistent decisions; acts with integrity in all decisions; distinguishes relevant from irrelevant information; makes timely, appropriate decisions.

· Strategic Planning and Organizing: Understands company vision and aligns priorities accordingly; measures outcomes; uses feedback to redirect as required; evaluates alternatives; appropriately organizes complex issues to desirable resolution

· Communication: Connects with peers, subordinate employees and all customers; actively listens; clearly and effectively shares information; demonstrates effective oral and written communication skills; negotiates effectively.

· Quality Improvement: Strives for efficient, effective, high-quality performance in self and in the department; delivers timely and accurate results; resilient when responding to matters that are challenging; takes initiative to make improvements

· Leadership: Motivates others; accepts responsibility; maintains high morale in department; develops trust and credibility; expects honest and ethical behavior of self and staff

· Teamwork: Encourages cooperation and collaboration; builds effective teams; works in partnership with others; is flexible; responsive to the needs of others

· Development: Maintains up-to-date skills through involvement with professional organizations and/or continuing education

 

III. Customer Service

· Maintains the highest level of customer service v