Job Summary

Responsible for the authorizations and admissions program. The Regional Director of Admissions oversees the referral and intake processes and maintains communication with the sales and operations teams. The Regional Director is responsible for ensuring the compliance and regulatory standards at each of their assigned hospitals and must work close with the managers, coordinators, and specialists to create and maintain efficient and effective processes. Works closely with the Regional Leadership team to ensure that the authorizations and admissions processes and performance meet the targets set forth by the organization.

Essential Functions

• Oversees and leads the operations of the Regional Admissions office, including supervision of the Clinical Appropriate Management Specialists, Admissions Managers, Admissions Coordinators, and Admissions Specialists.
• Review key performance measures in authorizations and admissions and prepare recommendations to improve overall performance.
• Serve as a liaison with regional sales, marketing, business office, managed care, and administration of the facilities to ensure timely processing of admissions and to ensure total customer satisfaction.
• Support coordination of admissions with other departments by facilitating the collection and distribution of appropriate information
• Train and orient new Managers of Admissions and assist with cross-training of staff for authorizations and admissions backup purposes.
• Establish and maintain protocols and processes to preserve data integrity across all systems. Conduct regular audits to ensure appropriate controls are in place.
• Serve as a resource for staff who may experience difficulties with various referral sources or payor organizations; provide specific interventions if necessary.
• Maintain state-of-the-art knowledge of areas of responsibility and develops and follows a program of continuing education.
• Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
• Ensure all concurrent denials are reviewed for appropriateness and appealed when patient meets LTAC continued stay criteria. Escalate to medical staff for Peer-to-Peer if needed.

Knowledge/Skills/Abilities/Expectations

• Direct experience in third-party reimbursement and knowledge of how benefits under various insurance programs are applied in the post-acute care setting.
• Strong relationship building skills and a spirit to serve and ensure effective communication and service excellence.
• Strong knowledge of regulatory standards and compliance guidelines
• Critical thinking, problem solving, and decision-making capabilities.
• Computer skills that include Microsoft Office Suite including, but not limited to: Word, Excel, PowerPoint, and Outlook
• Must read, write and speak fluent English.
• Must have good and regular attendance.
• Approximate percent of time required to travel:
• Performs other related duties as assigned.
• Ensure the team has safeguards in place to protect the assets of Scion Health from initial verification/authorization to continued stay eligibility and authorization protocols.
• Analyze team members processes and actions to ensure that all activities are value add to the quality of patients stay and financial wellbeing of Scion Health.

Education

• Bachelor's Degree Required
• Masters Degree Preferred (clinical area preferred); or equivalent experience.

Experience

• Minimum of three (3) years of experience in case management, admissions office management or similar leadership capacity.
• Proven history of effective relationship management in a matrix reporting structure is preferred.
• Some travel may be required, but minimal.