Required Skills/Experience:
Demonstrate recent knowledge/experience within the past 4 years in discharge planning and utilization review.

Unit Details:
Screen new admissions daily for discharge planning needs.
Establish priority of visits based on screening criteria.
Patients with identified needs for follow-up are seen within one business day of identification, and the initial assessment is completed.
Reassessments are done every three days as needed for changes in medical status, diagnosis, or caregiver.
Review appropriateness of patient admissions and level-of-care needs (inpatient and observation), following policy and procedure if level of care is not met.
Initiate timely HINN notices and letters of reinstatement.
Coordinate patient appeal rights under the discharge appeals program.
Identify patients and families who have high-risk, complex psychosocial, financial, and legal needs and refer patients to appropriate resources.
Facilitate third-party reimbursement by responding to third-party payer requests for concurrent clinical information in support of ongoing services, with turnaround by day end.
Ensure that the interdisciplinary care plan and the discharge plan are consistent with the patient's required needs and covered services.
Participate in and facilitate the unit's daily rounds.
Act as a patient advocate by communicating with patients and families regarding adverse determinations and issues related to insurance coverage and ongoing care requirements.
Coordinate and communicate thorough and complete referral information to enhance a safe transfer of patients to other facilities or agencies.
Demonstrate knowledge of community resources and act as a resource to staff in providing safe and effective post-hospital care.
Participate in care conferences for patients across the continuum.
Evaluate continued length of stay for appropriateness.
Make appropriate referrals to the Physician Advisor when criteria are not met and resolution with the attending physician cannot be accomplished.
Identify days at risk for denial and initiate strategies to facilitate care and accomplish discharge.
Assist medical coders by obtaining necessary diagnostic and procedural information to assure appropriate reimbursement.

Shift & Scheduling:
Rotating days, every other weekend, and rotating holidays.

Pre-employment modules may be required for this role. Please upload any certifications or health documents you have to your profile to expedite your on-boarding process.

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