CLINICAL LIAISON - NORH CMR UNIT

Status: Full Time

Shift: varies; typically, 8am-4:30pm Monday-Friday, occasional weekend day

Exempt: No

Summary:

The Clinical Liaison serves as a key connector among referral sources, patients, and payors, leveraging clinical expertise to advocate for patient access to rehabilitation services. This role combines responsibilities for building referral relationships, coordinating pre-admission screenings, and assisting with the management of insurance denials through comprehensive appeals. Additionally, the role collaborates closely with the IRF Leadership and Intake staff to ensure a seamless admission process, accurate documentation, and compliance with regulatory requirements.

Other information:

Qualifications:

• Licensure/Certification: Current clinical licensure required (one of the following RN, AND, BSN, or MSN )
• Experience:
• Minimum 2 years of clinical experience, preferably in an Inpatient Rehabilitation Hospital setting, or Case Management. (IRF nursing not required, but preferred)
• Prior experience in marketing/sales or referral development preferred.
• Experience with insurance appeals and medical necessity documentation; strongly preferred.
• Skills:
• Excellent oral and written communication and interpersonal skills.
• Strong clinical assessment skills and proficiency with EMR systems.
• Ability to analyze medical records and author professional clinical narratives supporting necessity of IRF admission criterium.
• Formal sales training, customer service and quality improvement experiences are preferred.

Responsibilities:

Key Responsibilities:

Referral Development & Pre-Admission Coordination

• Build and maintain strong relationships with physicians, case managers, discharge planners, and payors to drive appropriate admissions.
• Assist and coordinate the intake and pre-admission screening process with emphasis on external referral sources
• Conduct on-site clinical assessments at referring facilities to determine suitability for acute rehabilitation.
• Educate patients and families on rehabilitation options, level of care, and participation requirements.
• Serve as the initial external contact for case managers, discharge planners, and hospital partners.
• Conduct face-to-face educational visits and in-services with healthcare professionals to communicate IRF admission processes.
• Document screenings, decisions, and communications accurately in EMR and/or tracking systems.
• Functions on behalf of the IRF as the vendor liaison for all Home Health, Home Care, Hospice, SNF, and Assisted Living service providers.

Collaboration with Intake Coordinator

• Partner with the Intake Coordinator to ensure accurate and timely completion of pre-admission paperwork and requirements.
• Share clinical insights during admission screenings to support appropriate placement decisions.
• Assist in managing referral waitlists by providing clinical input on prioritization.
• Communicate proactively regarding Medicaid screenings, Medicare criteria, and regulatory changes impacting admissions.
• Participate in interdisciplinary team meetings and case reviews to align treatment plans and admission strategies.
• Support the Intake Coordinator in maintaining compliance with MDS and RAI processes by providing clinical documentation as needed.

Clinical Appeals & Advocacy

• Assist with the review of denied insurance claims for medical treatment and analyze patient medical records to determine if the denial was justified.
• Understand and apply federal requirements for inpatient rehabilitation facilities when developing appeals.
• Collaborate with internal teams and payors to advocate for patient access to necessary care.