Heidi Semder

• Innovative strategies to enroll patients into the Landmark Health program
• Developed the relationship between Landmark and hospital personnel, patients, physicians, community organizations, retirement communities, assisted living, primary care, and skilled nursing facilities
• Coordinated meetings with community providers, home health providers, facility discharge planners, and health plan case managers; including preparation and delivery of presentations on Landmark’s services
• Used critical thinking skills to create outreach strategies that are designed to maximize patient awareness and registration into Landmark’s program
• Utilizes leverage reporting and dashboards to prioritize telephonic and field-based outreach to members
• Works in an entrepreneurial environment with minimal supervision
• Achievement mindset: ability to consistently hit sales targets
• Multi-tasking and work in a dynamic environment
• Exceptional communication and project management skills
• Proficient in the use of Microsoft office Word, Excel and PowerPoint
• Proven success with time management and territory organizational skills

• Assessed changes in the medical status of patients
• Managed chronic illness
• Administered medications
• Assisted with activities of daily living
• Created treatment plans for patients
• Created diet plans for the patient
• Provided hospice care
• Completed patient care documentation and other paperwork

Responsible for reviewing and making medical determinations as to the validity of health claims and levels of payment in meeting national and local policies as well as accepted medical standards of care. Applies clinical knowledge to assess the medical necessity for this Medicare Contractor.

Identifed clients who meet program criteria and will benefit from program services and to facilitate effective care transitions to the rehabilitation setting for these clients. The process typically involves the following steps:

• Early identification of candidates/potential clients.
• Education of clients, family members, referral sources, and external payers regarding the effective and efficient utilization of program services and available resources.
• Screening of clients through on site and/or telephonic assessment and record review in collaboration with physicians, nurses, therapists, social workers, case managers and other interdisciplinary team members involved in the client's care. If the client is unable to participate in an interview, family members or significant others may also be interviewed to obtain accurate information as to pre-morbid functional status, personal interests, cultural considerations, and discharge plans affecting the rehabilitation admission.
• Determination of medical stability, readiness for program participation, and that services recommended are appropriate, reasonable and necessary. This is done in collaboration with the physical medicine and rehabilitation physician or other licensed treating physician with specialized training and experience in rehabilitation.
• Facilitation of benefit eligibility and precertification by payers prior to the rehabilitation admission.
• Coordination of a smooth transition from the referring facility or site to the rehabilitation setting.
• Recommending appropriate level of care and services for clients who are denied admission and providing guidance for clients who may benefit from rehabilitation admission in the future.