The Clinical Navigator is responsible for providing immediate clinical assessment and admission approvals for referrals going to selected facilities in identified markets. Coordinates a successful clinical transition from the acute setting to the post-acute setting.
- Works directly with specific Dirs, Care Transition (DCT) & Area Dir, Care Transition (ADCT), facilities and hospital accounts on clinical referral review.
- Provides independent clinical approval and denial on referrals generated from specific hospital accounts.
- Communicates clinical documentation needs to Dirs, Care Transition (DCT's) and follows up with facility Dir, Nursing (DON) as appropriate.
- Ensures Successful Acute to Post Acute transition through elevated communication to facilities of patient needs and at risk items.
- Create and maintain an updated clinical capabilities grid for designated facilities.
- Perform on-site hospital assessments for patients in need of second level review for approval.
- Conduct monthly performance reviews with facilities on admissions practices and approval/denial trends
- Follow up with admissions within first 24 hours to ensure successful transition to Skilled Nursing Facility (SNF)
- Follow up on any patient that discharges from a facility in less than 5 days to determine cause of discharge to identify trends and to develop a facility performance improvement plan based on trends found.
- Responsible for updating and maintaining current CRM system with referral notes