Top 1 Clinical evaluator Jobs in Plano, Tx

Clinical Evaluator
Acute Rehabilitation Hospital of Plano —Plano, TX
- Full-time
- Nursing
- RN License
- Hospital
- Paid holidays
- Health insurance
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Clinical Evaluator
Acute Rehabilitation Hospital of Plano —Plano, TX
Clinical degree in a healthcare-related field whose education and scope of practice support competent assessment of medical conditions, functional status,…
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2d

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Clinical Evaluator

Acute Rehabilitation Hospital of Plano -
Plano, TX

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Job Details

Full-time
2 days ago

Benefits

Paid holidays
Health insurance
401(k)
Paid time off
Vision insurance
Employee discount
Gym membership
Life insurance

Qualifications

Collaborate with healthcare professionals
Case assessment
Electronic health records (EHR) management
Initial assessment (medical evaluation)
Phone communication
Word processing
Writing skills
Care documentation
English
Client relationship development
Clinical data entry
Clinical assessment documentation
Relationship management
Patient interaction
Productivity software
Managing patient records
Quality data entry

Full Job Description

Clinical Evaluator

Acute Rehabilitation Hospital
Plano, TX

Position Summary

Acute Rehabilitation Hospital in Plano, TX is seeking a Clinical Evaluator to join our interdisciplinary team. The Clinical Evaluator is responsible for completing timely and accurate patient pre-admission screenings (PAS), PAS updates, and ensuring CMS-13 compliance for patients referred for inpatient rehabilitation services.

This position works collaboratively with the Business Development team, including Clinical Liaisons, the Admissions Coordinator, Admissions staff, physicians, nursing, case management, therapy, and other internal and external stakeholders to facilitate the referral-to-admission process in a timely manner. The Clinical Evaluator serves as a clinical resource while supporting regulatory compliance, payer requirements, and exceptional patient care.

Minimum Qualifications

Clinical degree in a healthcare-related field whose education and scope of practice support competent assessment of medical conditions, functional status, rehabilitation potential, and risk for medical and functional complications.
Current unrestricted licensure in Nursing (RN), Medical Social Work (LMSW/LCSW), or Therapy (OT, PT, RT, or SLP) is required.
Minimum of two (2) years of Clinical Liaison experience preferred; prior Inpatient Rehabilitation Facility (IRF), LTACH, acute care, or case management experience preferred.
Excellent clinical assessment and critical thinking skills.
Excellent written, verbal, and interpersonal communication skills.
Ability to collect, document, analyze, and communicate clinical information accurately.
Strong relationship management skills with physicians, referral sources, patients, families, and interdisciplinary team members.
Knowledge of PPS payment and reimbursement systems, DRGs, case weights, CMS regulations, and payer authorization processes preferred.
Ability to prioritize multiple referrals while meeting established turnaround times.
Proficiency with Microsoft Office applications, electronic medical record (EMR) systems, word processing, and data entry.
Ability to multitask and effectively interact with internal and external customers.
Ability to communicate effectively in English by phone, in writing, and in person with staff, patients, families, physicians, and referral partners.

Essential Duties & Responsibilities

Clinical Assessment

Complete comprehensive pre-admission screenings (PAS) and PAS updates accurately and within established turnaround times (goal of two hours).
Evaluate referred patients to determine medical necessity, rehabilitation potential, and appropriateness for inpatient rehabilitation admission.
Review medical records, therapy evaluations, physician documentation, laboratory results, and clinical information to ensure patients meet rehabilitation admission criteria.
Ensure all documentation complies with CMS-13 requirements, Medicare regulations, hospital policies, and payer guidelines.
Collect, document, analyze, and communicate clinical information supporting admission decisions.

Insurance & Admissions Coordination

Review referrals to identify insurance requirements, pre-certification needs, financial coverage, and admission criteria.
Serve as the clinical liaison with the Admissions Office and insurance companies by providing clinical documentation necessary to obtain pre-certifications and prior authorizations.
Monitor pending referrals and proactively follow up on internal and external issues affecting referral and admission timelines.
Maintain accurate documentation within the electronic medical record and other required systems.

Collaboration & Relationship Management

Develop and maintain strong working relationships with physicians, referral sources, hospitals, case managers, discharge planners, Clinical Liaisons, Admissions staff, and hospital leadership.
Maintain open communication with the Director of Business Development, Clinical Liaisons, Admissions, nursing, and interdisciplinary team members to promote teamwork, cooperation, and mutual respect.
Serve as a clinical resource regarding rehabilitation admission criteria, payer requirements, and referral appropriateness.
Deliver exceptional customer service while fostering positive relationships with patients, families, and referral partners.

Quality & Performance

Maintain knowledge of PPS payment and reimbursement systems, DRGs, case weights, Medicare regulations, and current inpatient rehabilitation admission requirements.
Achieve established individual productivity and performance goals.
Participate in quality improvement initiatives, departmental meetings, and ongoing education as assigned.
Maintain HIPAA compliance and protect patient confidentiality at all times.
Perform additional duties and special projects as assigned.

Benefits

Medical Insurance
Dental Insurance
Vision Insurance
Company-Paid Life Insurance
401(k) Retirement Savings
Supplemental Voluntary Benefits
Paid Time Off with Cash-Out and Donation Options
Paid Holidays
Pay on Demand (Payday Advance)
Gym Membership and Fitness Program Discounts
Employee Discounts on Everyday Purchases and Services
Access to Automobile and Home Insurance Marketplace
And More!

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Clinical Evaluator

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