Remote Admissions and Authorizations Specialist - MANAGED CARE REQUIRED

About the position

The position is responsible for managing the entire admission process within a healthcare facility, ensuring effective communication and coordination with internal referral sources and various departments. The role emphasizes program development, quality improvement, and productivity enhancement in an interdisciplinary model, while also serving as a liaison with marketing, business office, and administration.

Responsibilities

• Coordinate the patient admission functions in alignment with the hospital's mission and vision.
• Facilitate the admission of patients from referral sources.
• Apply clinical guidelines to pre-admission data.
• Identify and communicate specific patient needs for equipment, supplies, and consult services.
• Complete initial review of referrals for clinical and financial approval, escalating to leadership as necessary.
• Verify admission insurance benefits and manage pre-certification requirements.
• Handle denial management processes, including coordinating Peer to Peer and initiating expedited appeals for insurance denials.
• Provide the hospital team with necessary information on pending and new admissions.
• Coordinate bed availability with the nurse manager and expedite transfers.
• Participate in continuing education and professional development activities.
• Maintain a professional image and attitude towards patients, families, clients, coworkers, and others.
• Adhere to Scion Health policies and practices.
• Learn and develop knowledge of the Central Admissions Department (CAD) admission process and related systems.
• Establish positive relationships and open communication with referral sources and internal customers.

Requirements

• Graduate of a bachelor's degree program in a healthcare-related field or equivalent experience.
• Healthcare professional licensure preferred (e.g., RN, LPN/LVN, Respiratory Therapist, Physical Therapist, Occupational Therapist, or Social Worker).
• Experience in a healthcare-related area is preferred.
• Work experience with an adult geriatric disabled population is desirable.

Nice-to-haves

• Experience in managed care settings.
• Strong interpersonal skills and ability to develop relationships with referral sources.

Benefits

• Continuing education opportunities.
• Professional development activities.