Clinical Nurse Specialist- Precertification

Haverhill, MA
Full Time
Whittier Rehabilitation Hospital Bradford
Mid Level
Clinical Nurse Specialist/Precertification- Whittier Rehab Hospital - Bradford 
Department: Medical Care Evaluations
Full-time, 40 hours/week, Day shift- Mon-Fri
Pay Rate: $40.00-$42.00 per hour
Must be RN or LPN

Primary Function: Responsible for reviewing potential patients pre-admission screening, inclusive of pertinent medical and financial information to ensure hospital payment capability. Develop, maintain, and evaluate systems to ensure appropriate levels of care according to 3rd party payers and other accrediting agencies standards

Typical Duties: The duties listed have been broken into the categories of "Essential" and "Non Essential" functions for purposes of evaluating an individual with a disability qualifying for the position. This section of the job description identifies all duties important in accomplishing the purpose of this position

Essential:
  1. Supervises and assists in all aspects of the referral and admission process
    1. Insures clinical appropriateness of all patients admitted
    2. Collaborates with the appropriate clinicians to render a definitive clinical decision to Medical Care Evaluators when required
    3. Insures insurance pre-authorization requirements are met on all patients admitted
    4. Assists in the prioritization of referral assignments to Medical Care Evaluators
    5. Provides potential patients and referral sources with accurate information updates regarding WRH's rehabilitation services
  2. Demonstrates the ability to complete pre-admission assessments on potential candidates for admission and render definitive clinical decisions
  3. Determines if the patient is likely to benefit significantly from an intense hospital level rehabilitation program of extensive inpatient evaluation
  4. Demonstrates working knowledge of Wellsky System
  5. Complies with corporate standards regarding financial clearance of referrals/admissions
  6. Demonstrates LTACH and Acute Level rehabilitation knowledge and principles
  7. Assists with departmental referral and admission monthly statistics to be incorporated into the monthly reporting
  8. Assumes responsibility as Department Director in his/her absence
  9. Participates in the development of departmental goals and objectives
  10. Works with Administrator(s) and Department Director to identify and coordinate potential admissions.
  11. Collaborates with the Director in the completion of employee performance evaluations
  12. Participates in the development of and compliance with a defined budget
Non-Essential:
  1. Assists in the development and implementation of departmental policies and procedures consistent with hospital wide policies and practices
  2. Assists evaluators with in-services to physician groups, discharge planners/social workers and insurance case managers to the availability of Whittier Rehabilitation services to meet the needs of their patients
The above statement reflects the general duties considered necessary to describe the functions of the job as identified, and shall not be considered as a detailed description of all the work requirements that may be inherent in the job.

Prerequisites:
  1. Knowledge of growth and development across the life span
  2. Registered Nurse with current Massachusetts license, BSN preferred; or Bachelors of Scient in health-related field; or Licensed Practical Nurse with 2+ years of clinical experience
  3. Knowledge of all aspects of the admission process, including insurance verification, and pre-certification
  4. Working knowledge of the insurance industry and how it relates to the admissions process
  5. Ability to coordinate, manage and prioritize multiple projects and tasks
  6. Ability to operate standard office equipment such as personal computer, copy machine, and fax machine
  7. Possess a regard for confidentiality
  8. Knowledge of administrative policies and procedures
  9. Effective communication skills, both oral and written
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