Clinical Liaison RN

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well‑being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives. Work Shift Various (United States of America) Job Summary The Clinical Liaison is a member of the care coordination department and is responsible for participating in the referral coordination for local hospitals. He/she functions as a marketing representative for clinical referrals, interacts with case managers, admission coordinators, and other liaisons on site, reviews the clinical chart of potential long‑term acute care patients, and initiates the admissions process with the admissions coordinator. The liaison also uses InterQual and NALTH criteria to assess patients and must possess a basic understanding of Medicare, Medicaid, and private insurance. Core Responsibilities and Essential Functions Conduct a review of data to determine admission eligibility and health care needs. Review information from referring facilities. Review screening assessment for necessity and appropriateness of health services using established criteria (e.g., NALTH, InterQual). Identify and refer for alternative levels of care in a timely manner. Complete and coordinate paperwork required by post‑discharge providers. Identify potential care needs based on assessment. Assess insurance and coverage issues such as managed care, PPO, HMO, and the identification of preferred providers. Identify issues related to patient type, admission, or continued stay and collaborate with physician/physician advisor for resolution. Monitor compliance with Medicare/Medicaid regulations, including appropriate billing and patient type. Review insurance of potential patients, discuss validity and discharge plan with patient/family. Assess various forms of insurance for in‑network vs. out‑of‑network benefits. Initiate the pre‑certification process: contact insurance companies for authorizations and verify Medicare days. Perform other duties as assigned. Comply with all Wellstar Health System policies, standards of work, and code of conduct. Required Minimum Education Associate’s degree in Nursing (required) Bachelor’s degree in Nursing (preferred) Required Minimum License(s) and Certification(s) RN – Registered Nurse (Single State) or RN‑COMPACT – Registered Nurse (Multi‑state Compact) BLS – Basic Life Support from the American Red Cross or American Heart Association Required Minimum Experience Minimum 2 years of clinical experience directly related to ICU/IMCU patients in an acute setting (preferred) Minimum 1 year of LTAC or previous liaison experience (preferred) Required Minimum Skills Excellent communication skills, able to handle incoming and outgoing calls, visitors, and other customers in a professional and courteous manner. Organized and capable of handling multiple tasks simultaneously. Demonstrates ability to interview patients, staff, and visitors with effective written and/or verbal communication skills. Knowledgeable of screening criteria in review of clinical data with respect to patients/clients needs for health care. Ability to effect change, perform critical analysis, promote client/family autonomy, and plan and organize effectively for the continuum of care. Knowledge of funding resources, community resources, services, and clinical standards and outcomes. Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more. #J-18808-Ljbffr Wellstar Health System