Rehab Admissions Coordinator Day Shift - Wyandotte Hospital

General Summary

Under the direct supervision of the Director of Rehab Services, performs proactive case finding and screens patients for appropriateness for inpatient rehabilitation. Markets/educates referral sources (case managers, therapists and physicians) on inpatient rehabilitation in order to grow our business.

• Coordinate the placement of all rehab admissions and transfers in accordance with clinical standards and guidelines.
• Perform onsite and telephone preadmission screening and clinical assessment for all proposed admissions.
• Coordinate bed utilization for all internal and external points of entry.
• Educate patients/family, referral sources, internal and external payers and case managers, as to rehab program benefits/services and current insurance and criteria related issues.
• Communicate with third party payers to obtain necessary authorization for reimbursement of services.
• Recommend alternate level of care for those candidates who are denied admission.

• 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…