LAUREN LITTLEMAN

Determined which managed care insurance patients utilized by generating & reviewing the common working file. Ran verification of benefits for skilled nursing facility services through portals and via phone. Submitted prior authorizations through portals and via phone. Submitted continued stay clinical documentation for patients. Sent approvals, denials, & peer to peer information to centers. When needed completed review & discussions with insurance case managers. Financially approved based off of benefits reviewed.

• As a Clinical Intake Coordinator, you will be responsible for reviewing and approving potential admissions clinically and financially. Coordinate admissions and hospital transfers to an appropriate SLP skilled rehabilitation and nursing center.
• Be responsible for reviewing and approving potential admissions clinically and financially to our skilled rehabilitation and nursing centers.
• Apply your clinical knowledge derived from education and experience as foundation for gathering appropriate clinical data to ensure appropriate placement, transfer facilitation, communication, and accurate documentation.
• Work collaboratively with team members ensuring appropriate patient admissions and exceptional customer experience.
• Decides acceptance of patients and coordinates admission process with ADPS and center Admin, DON and BOM recognizing:
• o Referral’s clinical needs.
  o Availability of necessary services, programming, and clinical competencies.
  o Reviewing, confirming, and communicating patient’s payor source to center along with supporting documentation.
  o Reviewing and confirming managed care insurance to Managed Care Manager for prior auth;
  o Work with ADPS for Family and/or responsible party confirmation of resources for Medicaid or SSI pending patients; and knowing bed availability in centers that you cover
• Efficiently and effectively, work with ADPS who manages all referrals.
• Communicate with Administrators, DON’s, and BOM’s regarding patient care issues, needs, and concerns and advise when appropriate.
• Work collaboratively with centers to manage all internal and external patient movements and the allocation of bed assignments.
• Communicate with Administrator and DON if placement of a specific patient will be problematic. Use problem-solving skills to determine the best course of action, which will be satisfactory to the patient, the DON, and the center.
• Make suggestions and utilize creative thinking and acquired knowledge to assess situations and improve decision-making and action.
• Coordinate transfers from the hospitals to our centers.
• Be responsible for documenting and tracking all referrals, admissions, hospital transfers and transports.
• Assist in data collection, monitoring, evaluation, and analyzing of problems for the purpose of developing and implementing protocols, policies, and procedures.
• Follow specific protocols, policies, procedures, and utilize established resources.
• Respond to all referrals with the aid of an electronic database of service profiles, approved clinical protocols and healthcare information.
• Obtains appropriate clinical documentation to support services and/or reimbursement level and financial documentation to support qualified payor source.
• Uses Referral Screening form to screen residents; ensure PASSR is completed upon admission and copy to center. Obtains accurate information from physicians, patients, and referral sources regarding the expected discharge plan.
• Responds to calls and/or inquiries regarding potential admissions and responds to these calls within 15 minutes if possible. Document approval or denial on third party referral websites – Allscripts, CarePort, etc.
• Communicates information to ADPS and center sales/admissions teams, Administrator or Director of Nursing and Business Office Manager, when applicable and helps coordinates patient’s smooth transition into the center.
• Assists potential patients in selecting post-acute placement to Senior Living Properties centers.
• Develop and maintain relationships with referral sources; cooperate and collaborate with referral sources and colleagues.
• Provides VP of Sales & Marketing, COO, Regional Sales Managers, VPO’s, Regional teams and Center teams with information and feedback from the providers in the region.
• Adheres to established HIPAA confidentiality standards of patient/resident and client location information.
• Assists with generating additional referrals from hospital social services and discharge planning departments, physicians, case managers, insurance companies and new referral sources.
• Demonstrates growth in hospital referrals, as reflected in an increase of overall occupancy and quality mix in SLP centers.
• Read and familiarize self with State and Federal Nursing Facility regulations.
• Stay current and familiarize self with current healthcare and community trends including but not limited to Alternative Payment Models and changes in accounts, competitors, or healthcare community.
• Exhibit excellent customer relationship skills including telephone and personal contact with all of the call center’s customer groups, i.e. physicians and their office staffs, nurses, vendors and fellow employees, etc.
• Establish and maintains a high degree of awareness and knowledge of SLP’s medical staff, services and special programs.
• Maintain composure and customer-centric communication with challenging callers.
• Participates in off hour and weekend on call duty as assigned.
• Read and familiarize self with Nursing Facility 5-Star program along with Center ratings and understand how to respond to referral sources/ family members/ potential patients about ratings.

• Review and accept or deny all referrals, calculate medication cost on all referrals
• Daily I case manage to maximize reimbursement for Medicaid and Medicare
• Review incoming inquires for appropriate skilled needs and LTC Medical necessity
• I review PASRR forms upon admission and submit PL1s in accordance with state and Federal guidelines
• I submit LTCMI for Medicaid payment
• I work with direct care staff to review and discuss care provided and make sure it coincides with the plan of care
• Proficient in PDPM components
• Monthly Quality Measure review, QIPP and QRP
• ICD-10 review and coding proficient
• Work with insurance companies for authorizations and approvals
• Assess and Evaluate patients related to condition changes and report to Doctors or NP as needed
• Assess and Evaluate skilled patients on a daily basis for proper documentation and follow up for changes in plan of care.

• Daily I case manage to maximize reimbursement for Medicaid and Medicare
• Review incoming inquires for appropriate skilled needs and LTC Medical necessity
• I review PASRR forms upon admission and submit PL1s in accordance with state and Federal guidelines
• I submit LTCMI for
• Medicaid payment
• I work with direct care staff to review and discuss care provided and make sure it coincides with the plan of care
• Proficient in PDPM components
• Monthly Quality Measure review, QIPP and QRP
• ICD-10 review and coding proficient
• Work with insurance companies for authorizations and approvals
• Assess and Evaluate patients related to condition changes and report to Doctors or NP as needed
• Assess and Evaluate skilled patients on a daily basis for proper documentation and follow up for changes in plan of care.

• Provide direct patient care, monitor vitals, draw labs, administer mediations, daily documentation for skilled residents and long term care residents, communicate with MD/NP for new orders, change in condition, & abnormal lab results for patients.
• Provide leadership to the certified nursing assistants.

• Provide direct patient care, monitor vitals, draw labs, administer mediations, daily documentation for skilled residents and long term care residents, communicate with MD/NP for new orders, change in condition, & abnormal lab results for patients.
• Provide leadership to the certified nursing assistants.

I was a rehab director for 7 years and manged 2 facilities at a time at one point. Skilled in providing client focused, conscientious screens related to patient changes of conditions/need and report to appropriate staff. As well as consistent, personable, productive communication with evaluating therapist. Time management and scheduling of therapy staff and coordinations of evaluations and minutes therapists needed to spend with patients. Maintained professional and timely communication with patients, family members, physicians, and therapy staff while meeting cooperate productivity.