Workers' Compensation Liaison/Full time/Wallingford

Job Description

Job Description

Gaylord Specialty Healthcare is a health system dedicated exclusively to medical rehabilitation. We provide inpatient and outpatient care for people at every point in their journey from illness or injury to the most advanced state of recovery they can achieve. Our Mission: To enhance health, maximize function, and transform lives. Our values: Integrity, Compassion, Accountability, Respect and Excellence. These values guide us in providing quality patient care and transforming the lives of our patients.

SUMMARY:

The Workers Compensation Liaison will coordinate all health care services required for an organized, multi-disciplinary team approach to management of designated patient populations admitted under Workers’ Compensation Insurance. Coordinates with RHCM the admission of the patient from the Acute Care Hospital or referral source to Gaylord Hospital. Initiates and revises individualized care plans as indicated by assessment and patient response to treatment. Assesses quality, cost-efficient care to ensure the patient’s plan of care promotes a safe and timely discharge. Evaluates the overall plan for effectiveness. Involves the patient and family in the formulation of goals. Monitors appropriateness of admissions and continued stay. Facilitates the discharge planning with the patient, family, and Workers’ Compensation payer. Provides the link between provider and payer organizations, physicians, and the community in the transition of patient care through the health care system. In addition, provides a concierge-level of care for patients with catastrophic Workers’ Compensation injuries, ensuring a highly coordinated, personalized experience from pre-admission through the inpatient stay and continuing throughout outpatient treatment at Gaylord, with a focus on supporting key referral sources and stakeholders. Reports directly to the Director, Integrated Admissions and Care Management, and indirectly to the Medical Director of Workers’ Compensation.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

Clinical:

• Works in collaboration with the RHCM/admissions team on the Workers’ compensation referral, facilitates the admission of the patient, and accepts the ongoing management of care.
• Assures and facilitates appropriate and efficient utilization of hospital services, including ongoing assessment of conditions for continued stay for patients admitted under Workers’ Compensation. Demonstrates the willingness and ability to travel for onsite evaluations and marketing events/conferences, including some weekends.
• Performs comprehensive assessments and reassessments of the patient’s condition and discharge planning needs, including the psychosocial, physical, educational, and cultural aspects. Works with the clinical team to develop and modify the care plan to meet the patient's needs.
• Collaborates with other disciplines in patient evaluation and treatment and initiates referrals appropriately.
• Initiates discharge planning in a timely fashion, develops and revises individualized discharge plans as indicated by assessment and patient response to treatment. Evaluates overall plan for effectiveness; involves the patient and family in formulation of goals.
• Demonstrates an understanding of level of care contract tiers and reimbursement factors for home care, rehabilitation, residential treatment, outpatient, and long-term care in the development of discharge plans. Seeks alternatives to facilitate discharge planning.
• Provides patients and families support and information about their current disability.

Communication:

• Provides clinical information to Workers’ Compensation companies in a timely manner.
• Prevents denials through proactive intervention with Workers’ Compensation Insurance care management reviewers, physicians, and hospital staff.
• Acts as the principal communicator to the patient, families, and external case managers regarding Workers’ Compensation insurance benefits/reimbursement, treatment plan, progress, length of stay, and discharge plan.
• Provides education and support to staff regarding community resources, Workers’ Compensation Insurance payer issues, and Workers’ Comp legal issues.
• Demonstrates constant knowledge of the care level of the patient and the services expected from the Insurance Companies;
• Communicates with the Director of Integrated Admissions and Care Management to ensure appropriate reimbursement and execution of contracts related to the injured worker’s stay at Gaylord Hospital.

Professionalism and Expertise:

• Provides very personal/exclusive collaborative efforts to accommodate the payer, case managers, applicable attorneys, and the patient.
• Provides concierge-level coordination and oversight for catastrophic Workers’ Compensation cases, ensuring seamless transitions from pre-admission through inpatient care and into outpatient services, serving as a single point of contact for patients, families, payers and referral sources. Markets the Workers’ Compensation Program to the industry.
• Demonstrates an ability to be flexible, organized and functional under stressful situations. Utilizes critical thinking skills and sound judgment in priority setting and delegation.
• Practices autonomously, consistent with evidence-based standards. Pursues personal and professional growth and development.

Program Development & Stakeholder Relations:

• Serves as a primary point of contact and ambassador for Gaylord Hospital’s Workers’ Compensation Program, fostering strong relationships with referring hospitals, insurance carriers, nurse case managers, employers, attorneys, and other key stakeholders throughout the continuum of care.
• Provides a concierge-level experience for injured workers and their support systems, ensuring proactive communication, personalized service, and seamless coordination from initial referral through inpatient rehabilitation and outpatient follow-up services.
• Acts as an advocate and resource for patients, families, referral sources, and payers by addressing questions, resolving concerns, and facilitating timely access to services throughout the rehabilitation process.
• Collaborates with the Sales, Marketing, Admissions, and Clinical teams to support strategic growth initiatives for the Workers’ Compensation Program, including referral development, customer retention, and expansion of key business relationships.
• Participates in meetings, educational events, conferences, industry associations, and networking opportunities to promote Gaylord Hospital’s Workers’ Compensation Program and strengthen relationships within the Workers’ Compensation community.
• Assists in identifying opportunities for program growth, service enhancements, and improved customer satisfaction through ongoing communication with referral sources, payers, and patients.
• Maintains regular contact with referral partners, insurance carriers, nurse case managers, and other stakeholders to ensure a high level of satisfaction with services provided and to support long-term relationship development.
• Serves as a clinical resource during the referral review process by collaborating with Admissions, physicians, and clinical staff to evaluate prospective Workers’ Compensation referrals and facilitate appropriate placement.
• Supports the collection and communication of patient outcomes, success stories, and program achievements to referral partners and stakeholders, highlighting the value and effectiveness of Gaylord’s Workers’ Compensation Program.

Exhibits I.T.I.S.I.C.A.R.E values:

• Innovation : Embracing creativity and new ideas to improve processes and outcomes.
• Teamwork : Collaborating effectively with others to achieve shared goals and objectives.
• Inclusion : Fostering an environment where everyone feels valued and supported.
• Safety : Prioritizing the well-being and security of patients, individuals, and communities.
• Integrity : Acting with honesty and transparency in all interactions and decisions.
• Compassion : Showing empathy and kindness towards others, especially in challenging situations.
• Accountability : Taking responsibility for actions and outcomes, ensuring reliability and trust.
• Respect : Treating others with dignity and consideration, valuing their perspectives and contributions.
• Excellence : Striving for the highest quality in performance and achievements.

QUALIFICATIONS :

• At least 2 years of documented relevant clinical experience in conjunction with Workers’ Compensation experience.
• Results-driven individual with high energy and a strong desire for success.
• Strong organizational and time management skills.
• Advanced presentation skills with demonstrated ability to present in a group setting.

EDUCATION and/or EXPERIENCE:

• Registered Nurse (RN) or other licensed health care providers; experience in the Workers’ Compensation industry, specifically approving services and case management, is preferred, as well as strong clinical experience in a hospital setting.
• Additional experience in the Workers’ Compensation industry, home care, and/or long-term care is desirable.
• Strong leadership, interpersonal skills, strong problem-solving, goal setting, and decision-making skills.
• Experience with multi-aged and multicultural populations.
• Knowledge of legal and regulatory issues and insurance and third-party reimbursement.
• Experience with medical cost containment, resource utilization.

HOURS:

Full time/Mon-Fri

We Are An Equal Opportunity Employer