Admission Navigator ER, Full Time, Flex Shift

POSITION SUMMARY:

The Clinical Documentation Liaison has primary responsibility for performing reviews of all ER patients ESI 3A or 3B for meeting criteria either observation or inpatient admission. This includes utilization of AI tools for predictive analysis and InterQual criteria for admission review. This staff member has regular and daily interaction and strong working relationships with Hospitalists and ED Physicians, Physician Advisors. Also works closely with handoff to UR Authorization Coordinators (who submit all relevant data to payors to obtain authorization), Physicians and Nurses (orders, clinical documentation, status updates).

KEY RESPONSIBILITIES:

Performing all Initial Inpatient Admission and admit for Observation Status Reviews (utilizing MEDITECH

documentation, InterQual or equivalent ADR/CCR UR Criteria Measurement Software Solution)

Initial reviews will be performed to ensure appropriate medical necessity for the inpatient status or placement of patient

in observation

• Advise Hospitalist or Admitting Physician of outcomes of patient meeting criteria, set forth future reviews (using MEDITECH, InterQual & Iodine solutions)
• Communicates with the physicians and clinicians regarding orders and documentation related to status.
• Exhibits the ability to work independently and manage technology in a fast-paced environment supports Steward Health Care's and hospital/company goals and objectives. Works within regulatory compliance guidelines.
• Care Navigation activities such as follow up appointments, OP diagnostic testing scheduling as needed for patient’s not requiring admission to the hospital
• Appropriate referral to Case Manager for discharge planning as needed.
• Other duties as assigned

REQUIRED KNOWLEDGE & SKILLS:

• Clinical/Medical acute
• Understanding of admission review criteria (InterQual®, MCG®)
• Must have experience or skills to work competently with computer-based charting and other clinical and non-clinical software programs
• Must have knowledge of or be willing to learn patient status, InterQual Criteria, Milliman Criteria
• Working knowledge or be willing to learn criteria for Medicare, Medicaid, HMO, and private insurance carriers
• Ability to read, write and communicate effectively in English (bilingual-Spanish preferred in FL)
• Time management, multi-tasking and adaptability to change are all required skill sets in this role
• Ability to read and communicate effectively in English (Spanish or bilingual preferred in FL)
• Possess critical thinking skills.
• Demonstrates initiative and proactive approach to problem resolution.
• Ability to effectively interact with ED Physicians, Hospitalists, Physician Advisors, Utilization Review staff (remote), Case Management staff (onsite at hospital) and community healthcare resources.
• Ability to work onsite independently in a fast-paced environment engaged as active team member.
• Understand or be willing to learn, patient status, InterQual Criteria, Milliman Criteria

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

• Education: Minimum of BA/BS or enrolled in BA/BS program and must be aspiring to work in the medical field: MD/DO, Registered Nurse, Nurse Practitioner or Physician Assistant
• Experience (Type & Length): Ability to navigate technology in a fast-paced healthcare environment
• Certification/Licensure: Healthcare training and/or licensure in any medical filed, as well as clinical experience preferred
• Software/Hardware: Ability to learn and navigate an electronic medical record and clinical documentation system(s), Microsoft Office applications – Outlook, Excel, Word
• Other: Understanding of the health care delivery setting