Paradigm Healthcare, LLC Director of Admission - Nurse in Lincolnwood, Illinois
The primary purpose of the Referral Management Specialist is to manage the administrative components of a clinical referral from key hospitals and other care settings. The Referral Management Specialist facilitates intake processes, care coordination, and referral source management while ensuring a smooth transition of care for patients discharging from another care setting to one of our facilities. The Referral Management Specialist will work closely with the facility leadership to ensure the coordination of an admission is done quickly, efficiently, and accurately. The Referral Management Specialist receives new referrals and clinical documentation and works with the Regional Directors of Care transitions to make sure the patient receives proper placement and appropriate levels of care.
Paradigm Healthcare was founded on the belief that by empowering each other, we can achieve more and provide better care to every patient we serve. We believe in taking a fundamental and basic human approach to our business, keeping it simple, real and to the point. We believe that by building an empowered team, who knows the value they hold, we can provide an unparalleled level of care to the residents who count on us
- Maintains a current, valid, and active Registered Nurse/LVN License
- Work with Director of Business Development to improve and optimize the admission process
- Collaborate with facility department heads to support admission needs at each location
- Responds to referrals from hospital discharge planners, families, and other referral sources. Manages the referral process professionally, timely and with appropriate follow-up. Manages the admission process by maintaining updated bed availability and facility services information. Effectively manages occupancy levels and census/premium mix enhancement.
- Coordinating the resident referral and approval process in an efficient manner and the ability to make quick admission and financial decisions; Focus on converting inquiries into admissions
- Understand the admissions process including policy, procedures, assessments & paperwork requirements
- Prepare reports daily, weekly, and monthly on all admissions, conversions, and denials
- Maintain knowledge of regulations governing Medicare/Medicaid/Managed Care reimbursement processes and with managed care authorization and pre-certification processes
- Ability to multi-task and work under time constraints
- Works through and processes referrals expediently and accurately; Verifying information received by referral sources and orchestrating the communication of ordered care for our residents into PCC and facility teams.
- Establishing primary care physicians and obtaining necessary orders to provide care
- Collaborates with RDCT’s to make sure all requirements are met for insurance coverage
- Informs the RDCT’s of any referral source issues that arise during the referral process
- Confirms eligibility of patient benefits with insurance companies and receives authorization for admission as needed
- Completes pre-admission, registrations, and clinical evaluations to assist in the evaluating appropriateness of admission per policy
- Ensure financial verification is accurate and complete before the patient is admitted to the facility and assist in reducing accounts receivable
- Possess ability to deal tactfully and courteous in any situation communicating well, verbally and in writing. Must have excellent customer service skills as well as excellent verbal and written communication skills.
- Communicates professionally with all medical staff, interdisciplinary team, leadership, insurance companies, hospitals, and with all external professional groups and agencies.
- Follows up daily on all active and pending inquiries. Assist with increasing conversion rate by following up on all referrals immediately
- Collects and distributes all admission information to the assigned facility leadership
- Possess strong analytical and technical skills to review, prepare, and interpret medical reports and related material and make logical recommendations.
- Maintain a thorough knowledge of the facilities services, Clinical Capabilities, and physician relationships
- Monitors rotation of admissions and informs CRF staff of status of referrals as they occur. Ensures process is transparent
- Accepts and sends information via fax as needed
- May be required to complete an extended work schedule to ensure completion of essential duties or adequate processing of a referral
- Maintains current database of existing and potential referral sources.
- Inputs daily referrals and admissions data into PCC CRM
- Must have basic computer knowledge and excellent attention to detail.
- Able to work independently, self-motivated and goal oriented. Demonstrates self-confidence.
- Ability to establish and maintain working relationships with multiple and varied people and organizations.
- Education: Master’s, Bachelor’s or Associate’s RN or LVN
- Two to three years’ experience with the admissions process at a SNF, subacute, rehab, or other health care facility
- Strong utilization knowledge of Point Click Care
- Basic clerical and office function skills; excellent verbal and written communication skills and interpersonal relationship skills.
- Professional telephone skills with the ability to handle referral calls effectively and efficiently meet the needs of the referral sources and families
- Genuine caring for and interest in elderly and handicapped people
- Ability to comply with the Patients Bill of Rights and the Employee responsibilities
- Ability to read and write the English language
- Self-motivated and self-directed