Clinical Referral Specialist

Clinical Referral Specialist

The Clinical Referral Specialist will manage incoming referrals that need further clinical review and back up Community Referral Specialist when necessary. They will evaluate referrals for admission to PruittHealth leveraging clinical experience and an understanding of Home Health agencies. We are looking for someone with a clinical background interested in helping patients get the opportunity to obtain services by PruittHealth and support Community Relations Representatives sustain business partnerships with referral sources. In this cross-functional role, the Community Referral Specialist will engage with partners across disciplines, from external hospitals and healthcare systems to Pruitt administrators, clinical managers, and Community Relations Representatives.

Key responsibilities include:

• Review patient referrals and respond on behalf of PruittHealth
• Accurately completes referral documentation as necessary to facilitate the admissions process.
• Reviews physician orders and follows up with referral source for clarifications or additional information if needed.
• Identifies objections, concerns, or other entry barriers and provides information in response to address those issues. Proactively offers alternatives if the agency is unable to provide services.
• Processes and documents referrals that are not accepted for admission, indicating specific reason for non-acceptance.
• Escalate issues or barriers to manager.
• Collaborates with revenue cycle team to understand payors.
• Access multiple electronic health systems to receive referrals
• Understand daily agency statuses across staffing, payor, and clinical abilities and manage points of contact across assigned agencies.
• Partner closely with sales partners, admins, and clinical managers
• Support further processing referrals, vet payors, and conduct welcome calls when needed
• Perform other related duties as necessary and as directed by supervisor

Knowledge, skills, abilities:

• Fluent with all regulatory agencies, reimbursement systems and levels of care.
• Must be knowledgeable of private insurance and Medicare coverage criteria, rules and regulations.
• Assists in the evaluation of patients to ensure that they are appropriate for admission.
• Taking responsibility for a regional territory of hospitals and community services in order to facilitate placements within the network of providers.
• Communicating referral needs within our structure and facilitating admissions into the network of providers.
• Must provide excellent customer service to all referral sources and network of providers if conducting outreach in support of the Community Relations Representative.
• Ensure we obtain all documentation necessary to support the focus of care.
• Be able to learn how to use multiple electronic health systems and platforms to receive referrals.
• Attend and participate in continuing educational programs to keep abreast of changes in your field as well as to maintain current license/certification, as required.
• Honor patients/residents' rights to fair and equitable treatment, self-determination, individuality, privacy, property and civil rights, including the right to wage complaints.
• Communicates well with patients/residents/clients and family members providing warm and friendly greeting and an approachable attitude to families, visitors, patients/residents/clients and responds to expressed concerns while displaying a helpful, caring demeanor. Answers questions when appropriate in a professional manner.
• Commits to high ethical standards and complies with the Code of Conduct, state and federal regulations, accreditation standards, and policies and procedures; maintains confidentiality of patient and employee records and information; has a duty to report compliance concerns, significant legal risk questions, fraud, abuse, suspected or actual misconduct to management.

Minimum education required:

Two (2) years of college or business school and/or equivalent combination of experience and training.

Minimum experience required:

One (1) year experience in Healthcare Sales/Marketing, or any equivalent combination of experience and training which provides the required knowledge, skills, and abilities.

Minimum licensure/certification required by law:

n/a

Additional qualifications:

• RN of 2 years of experience or LPN of 5 years of experience
• 1 - 3 years of experience in Home Health agencies or Skilled Nursing Facilities
• 1 year experience in Healthcare Sales / Marketing, or any equivalent experience or training

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We are eager to connect with you! Apply now to get started at PruittHealth!

As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.

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