Clinical Preassessment Review Specialist | PAM Health Corporate

Overview

The Clinical Pre Assessment Review Specialist works under the direction of the Executive Vice President of Business Development and is responsible for conducting and completing comprehensive reviews of clinical documentation as it relates to the preadmission screen (PAS), prior to admission. This role evaluates thoroughness and accuracy of clinical documentation and identifying opportunities for improved documentation in the preadmission screen (PAS). The specialist provides education and real-time feedback to Clinical and Physician Navigators (CN/PN) and Directors of Strategic Initiatives and Integration (DSI)

Responsibilities

I. Position Responsibilities

• Displays knowledge of both inpatient rehabilitation and long-term acute care (LTACH) admissions criteria for preassessment analysis.• Review patient medical records and utilize clinical and regulatory knowledge and skills, as well as, knowledge of payer requirements to ensure preadmission screens (PAS) contain all the required elements of documentation.• Completes real time edits to the preadmission screen (PAS) to ensure it contains all necessary and required elements of documentation.• Utilize pre-existing criteria and other resources and clinical evidence to develop sound preadmission screens (PAS).• Apply evidence-based guidelines to determine medical necessity.• Communicate preadmission screening (PAS) recommendations effectively.• Educates, supports and serves as a resource to Clinical and Physician Navigators (CN/PN) and Director of Strategic Initiatives and Integration (DSI).• Communicates with facility Admissions department and facility CEO on a daily basis to optimize census management and case finding strategies.• Demonstrates excellent written communication. Writes clearly and informatively; edits work for spelling and grammar; varies writing style to meet needs; presents numerical data effectively; able to read and interpret written information.• Other duties as assigned.

Documentation Reporting

• Effectively maintains log of all pending cases and weekly productivity report.• Excellent communication and collaborative skills.

PAM HEALTH JOB DESCRIPTION• Timeliness of reviews and decisions.• Provides daily verbal/telephone/email updates on all pending patients.• Maintains territory Account Management System.

II. Leadership

• Inclusiveness: Promotes cooperation, fairness and equity; shows respect for people and their differences; works to understand perspectives of others; demonstrates empathy; brings out the best in others and in his/her team• Managing Staff: Coaches, evaluates, develops, and inspires staff; sets expectations; recognizes achievements• Stewardship and Resource Management: Demonstrates accountability and sound judgment in managing company resources; appropriate understanding of confidentiality and company values; adheres to and supports company policies, procedures and safety guidelines• Problem-Solving: Identifies problems and involves others in seeking solutions; conducts appropriate analysis and searches for best solutions; effectively and efficiently implements appropriate responses to correct problems; responds promptly and effectively to new challenges• Decision-Making: Makes clear, consistent decisions; acts with integrity in all decisions; distinguishes relevant from irrelevant information; makes timely, appropriate decisions.• Strategic Planning and Organizing: Understands company vision and aligns priorities accordingly; measures outcomes; uses feedback to redirect as required; evaluates alternatives; appropriately organizes complex issues to desirable resolution• Communication: Connects with peers, subordinate employees and all customers; actively listens; clearly and effectively shares information; demonstrates effective oral and written communication skills; negotiates effectively.• Quality Improvement: Strives for efficient, effective, high-quality performance in self and in the department; delivers timely and accurate results; resilient when responding to matters that are challenging; takes initiative to make improvements• Leadership: Motivates others; accepts responsibility; maintains high morale in department; develops trust and credibility; expects honest and ethical behavior of self and staff• Teamwork: Encourages cooperation and collaboration; builds effective teams; works in partnership with others; is flexible; responsive to the needs of others• Development: Maintains up-to-date skills through involvement with professional organizations and/or continuing education

III. Customer Service

• Maintains the highest level of customer service via courtesy, compassion and positive communication.• Promotes the mission and vision of PAM Health within the work environment and the community.• Respects dignity and confidentiality by adherence to all applicable policies and procedures.

IV. Health and Safety

• Works in a manner that promotes safety; wears clothing appropriate to the performance of the job.• Participates in OSHA required training.• Follows universal precautions as appropriate for position; complies with Employee Health requirements for continued employment.• Reports unsafe practices to management.• Knows own role in case of an emergency.

Qualifications

Current licensure in nursing, respiratory therapy, physical therapy, occupational therapy, or speech and language therapy is required. Prior clinical experience in post-acute care setting and/or acute care setting.

Experience:

Minimum of two years’ experience in the designated field of license, preferably with rehabilitation/LTACH experience.

About PAM Health

“At PAM Health, our culture is defined by the values we demonstrate every day. Every employee is expected to align their behaviors, decisions, and interactions with our core values. Not just in moments of recognition, but in their daily work routine. These values are the foundation of our mission, the standard for our performance, and the compass for how we treat patients, families, and one another. Upholding these principles is not optional; it is a shared commitment to excellence and healing.