Clinical Liaison
Company: Wellbe Senior Medical
Location: Mount Prospect
Posted on: August 5, 2022
Job Description:
Job Summary:The WellBe care model is a Physician Led Advanced
Practice clinician driven geriatric care (care of older adults)
team focused on the care of the frail, poly-chronic, elderly
Medicare Advantage patients. This population is typically
underserved and very challenged with access to care. To address
these problems, we have elected to bring the care to the patient,
instead of trying to bring the patient to the care. Care is
provided throughout the entire continuum of care - from chronic
care and urgent care in the home, to hospital, to skilled nursing
facility, to assisted living, to palliative care, to end of life
care. WellBe's physician/advanced practicing clinician led
geriatric care teams' partner with the patient's primary care
physician to provide concierge level geriatric medical care and
social support in the home as well as delivering and coordinating
across the entire care continuum. General Summary The Clinical
Liaison is responsible for managing the ongoing hospital census of
WellBe's patients. This candidate will help educate patients about
WellBe's program, close gaps in communication between patients and
attending physician, and coordinate smooth transitions
post-discharge. This candidate will also be responsible for care
coordination needs and supporting WellBe clinicians and Community
Medical Director (CMD) with operational and clinical tasks.Job
Description:SKILLS & COMPETENCIES
- Fosters a culture of best demonstrated practices, customer and
peer service-orientation, measurement, performance, accountability,
and continuous improvement
- Manage the Transition of Care Process from admission to
transition home (i.e, admission, discharge planning and
follow-up)
- Monitors active patients across care settings (hospitals and
SNF's)
- Visit facilities (hospital and SNF's on a routine basis)
- Serves as a resource for the patient and their family to help
solidify discharge and treatment plan
- Facilitation and clarification of patient's goals of care with
the facilities and attending physicians
- Assists with discharge planning from Inpatient or Skilled
Nursing settings
- Works collaboratively with the clinical coordinator to ensure
discharge data is appropriately documented and transition of care
visits are scheduled and verified with the patient/family
- Collaborates with Community Medical Director daily to review
the appropriateness of discharge plans
- Reviews with the CMD the medical necessity of Home Health
orders, orders for DME, and follows up with those HH agencies and
DME agencies on their treatment plan
- Facilitating access for the patients to verify their ancillary
services such as DME, Home Health, OP Rehab are in place and
meeting their needs
- Attends Interdisciplinary Team (IDT) meetings and provides
additional information on patients
- Face of WellBe in the hospital/SNF if physicians cannot be
onsite (e.g., bring in notes, POLST, etc.), patients know them as
WellBe, and they are part of their WellBe program
- Assist physicians with communicating with attending of
record
- Arranges family meetings in the SNF and hospital
- Develop relationships in admitting, ED and Case Management
departments in facility setting
- Coordinates with Facility's Case Management and Social Work
Teams on the discharge
- Develops relationships with SNF Administrators
- Obtains access to clinical records in the facility setting, and
reviews and facilitates medical records transfer to WellBe
- May conduct home visits based on community team needs
- Ability to explain the WellBe model and engage new members into
the program
- Other tasks needed to accomplish team's objectives/goalsJob
Requirements:QUALIFICATIONS Educational/ Experience Requirements:
- Minimum of 5 years as a Licensed Practical Nurse/Licensed
Vocational Nurse Health Plan/ Hospice Liaison experience
preferred.
- LPN/LVN Licensure required.
- Managed Care experience preferred.Required Skills and
Abilities:
- Superior interpersonal skills
- Experience charting in EMR skills
- Detail orientation
- Problem solving and thinking autonomously and owning the
solution
- Professional demeanor
- Knowledge of Geriatric Medical Practice/Terminology
- Innovative
- History of successful outcomes or quality-driven practices
- Ethical patient care
- Teamwork/Can-Do Attitude
- Advanced computer skills (ie. Excel filtering and advanced
features, Google/Gmail, etc.)
- Strong communication skills (verbal and written) Travel
requirements: Travel may be required up to 100% locally. Work
Conditions: Ability to lift up to 20lbs. Moving lifting or
transferring of patients may involve lifting of up to 50lbs as well
as assist with weights of more than 100lbs. Ability to stand for
extended periods.Ability to drive to patient locations (ie. home,
hospital, SNF, etc). Fine motor skills/Visual acuity The preceding
functions may not be comprehensive in scope regarding work
performed by an employee assigned to this position classification.
Management reserves the right to add, modify, change or rescind the
work assignments of this position. Management also reserves the
right to make reasonable accommodations so that a qualified
employee(s) can perform the essential functions of this role
Keywords: Wellbe Senior Medical, Mount Prospect , Clinical Liaison, Healthcare , Mount Prospect, Illinois
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