Physician Navigator

Overview

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

Responsibilities

I. Direct Marketing Identifies and targets new referral sources for PAM Health within assigned territory. Establishes and maintain strong relationships with referral sources in assigned territory through ongoingassessment and servicing of their rehabilitation needs. Performs in-person appointments to market PAM Health programs to designated referral sources within assignedterritory 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 suchprograms 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 geographicallyprohibitive or competitive time of admission will not allow. In the assigned market uses the fast track process tofacilitate 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 coverageand admission criteria. Serves as a navigator to the Admissions office for insurance companies and providesclinical information to obtain pre-certification from payers.

 After reviewing medical record and interviewing patient/family, obtains facility admission information to supportthe admission process; makes a recommendation regarding acceptance and level of care, and communicatesstatus 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 aresource to family members of current, past and potential patients. Communicates with facility Admissions department and facility CEO on a daily basis to optimize censusmanagement 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 AmericanExpress 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 theorganization. Assists in the development of new programs and enhanced services through ongoing assessment of stakeholderneeds 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 ofManaged Care as appropriateV. 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 forcontinued 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 onphysicians 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.