Physician Navigator - PRN | San Antonio Northeast Rehab

Referral Development Manager

This position is responsible for the relationship management aspects of referral development in a specific market. This includes physician office calls, networking and participation in professional healthcare organizations and support of community initiatives such as health fairs / screenings, Run / Walks or other community sponsored activities that provide opportunities to raise general awareness of PAM Health programs and services. Performs other related duties as assigned or requested. This is a non-exempt position that reports directly to the Director of Strategic Initiatives and Integration.

Responsibilities

I. Direct Marketing Identifies and targets new referral sources for PAM Health within assigned territory. Establishes and maintains strong relationships with referral sources in assigned territory through ongoing assessment and servicing of their rehabilitation needs. Performs in-person appointments to market PAM Health programs to designated referral sources within assigned territory and meet assigned objectives on a weekly basis. Communicates clearly, concisely and accurately. Maintains an excellent understanding of all inpatient / outpatient programs, including features and benefits of such programs throughout the system. Meets assigned objectives for weekly calls, joint marketing, professional tours and educational presentations.

II. Pre-Admission Assessment Maintains responsibility for patient referral until patient admits to PAM Health. Displays knowledge of both inpatient rehabilitation and long-term acute care (LTACH) admissions criteria for preassessment analysis. Coordinates and completes on-site pre-admission assessments on potential patients unless geographically prohibitive or competitive time of admission will not allow. In the assigned market uses the fast track process to facilitate referral conversions. Completes phone / FAX assessments if geographically prohibitive. Documents preadmission assessments legibly, accurately, and completely in the approved format. Reviews medical record of referred patient and identifies all aspects related to pre-certification financial coverage and admission criteria. Serves as a navigator to the Admissions office for insurance companies and provides clinical information to obtain pre-certification from payers.

After reviewing medical record and interviewing patient / family, obtains facility admission information to support the admission process; makes a recommendation regarding acceptance and level of care, and communicates status of admission to referral source as directed by the admissions department. Orients patient and / or family to facility services, including length of stay. Educates supports and serves as a resource to family members of current, past and potential patients. Communicates with facility Admissions department and facility CEO on a daily basis to optimize census management and case finding strategies. Follows up on all pending as well as medical denials in person to re-evaluate potential for admission. Conducts follow up with referral facilities to ensure satisfaction and service levels were met.

III. Documentation and Reporting Completes and submits weekly call reports in a timely manner. Submits time and expense reports and American Express receipts by second working day each month. Maintains a current and complete record of all contacts within assigned territory utilizing the sales database (Upshot). Maintains customer profiles (Physician, Case Manager, Employer, etc.) in Upshot and updates as needed. Contributes to ongoing market research by gathering information on the market and forwarding to management. Provides management with identified areas of need or activities that will enhance the marketing endeavors of the organization. Assists in the development of new programs and enhanced services through ongoing assessment of stakeholder needs of the market. Identifies new business / partnership opportunities and communicates to management.

IV. Managed Care Relationships Identifies opportunities for contracting with managed care companies and provider networks. Coordinates appointments with managed care companies and PAM Health Case Managers and / or Director of Managed Care as appropriate.

V. 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.

VI. 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

Education and Training : License in nursing, therapy or social work or significant healthcare experience in marketing. Computer literate and desire to enhance skills with PAM Health's information system software. Experience : Must have a minimum of two years of experience in healthcare sales / marketing. Prior experience calling on physicians is desired. Knowledge, Skills, and Abilities : Excellent clinical and assessment skills. Effective presentation and training skills. Excellent written and oral communication skills. Effective crisis management skills, with demonstrated facilitation and problem solving experience. Effective team leadership skills. Knowledge of PPS payment / reimbursement systems and DRG's / case weights. Knowledge of patient rights and commitment to patient advocacy. Ability to collect, document, and analyze data. Word processing and data entry skills. Network access to community, state, and national resources and health services organizations. Excellent relationship management skills with referral sources and physicians.