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.