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:Supervises and assists in all aspects of the referral and admission processInsures clinical appropriateness of all patients admittedCollaborates with the appropriate clinicians to render a definitive clinical decision to Medical Care Evaluators when requiredInsures insurance pre-authorization requirements are met on all patients admittedAssists in the prioritization of referral assignments to Medical Care EvaluatorsProvides potential patients and referral sources with accurate information updates regarding WRH's rehabilitation servicesDemonstrates the ability to complete pre-admission assessments on potential candidates for admission and render definitive clinical decisionsDetermines if the patient is likely to benefit significantly from an intense hospital level rehabilitation program of extensive inpatient evaluationDemonstrates working knowledge of Wellsky SystemComplies with corporate standards regarding financial clearance of referrals/admissionsDemonstrates LTACH and Acute Level rehabilitation knowledge and principlesAssists with departmental referral and admission monthly statistics to be incorporated into the monthly reportingAssumes responsibility as Department Director in his/her absenceParticipates in the development of departmental goals and objectivesWorks with Administrator(s) and Department Director to identify and coordinate potential admissions.Collaborates with the Director in the completion of employee performance evaluationsParticipates in the development of and compliance with a defined budgetNon-Essential:Assists in the development and implementation of departmental policies and procedures consistent with hospital wide policies and practicesAssists 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 patientsThe 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:Knowledge of growth and development across the life spanRegistered Nurse with current Massachusetts license, BSN preferred; or Bachelors of Scient in health-related field; or Licensed Practical Nurse with 2+ years of clinical experienceKnowledge of all aspects of the admission process, including insurance verification, and pre-certificationWorking knowledge of the insurance industry and how it relates to the admissions processAbility to coordinate, manage and prioritize multiple projects and tasksAbility to operate standard office equipment such as personal computer, copy machine, and fax machinePossess a regard for confidentialityKnowledge of administrative policies and proceduresEffective communication skills, both oral and written