the case manager is responsible to assist in the development, planning, coordination and administration of the activities of utliization review. conducts concurrent review of the medical record to determine appropriateness and medical necessity of admission, continued hospital stay and use of ancillary services. Assumes a leadership role within the interdisciplinary team to coordinate services thrugh the continuum of care to achieve optimal clinical and resource outcomes.
Performs Utilization Mangement functions.
Refers cases to the Medical Director as indicated
Develops and assists patients/families with an appropriate discharge plan
Identifies barriers to treatment and initiates a plan which supports optimal quality
Collaborates with all members of the healthcare team.
Assesses the data from the medical record to determine if documentation meets medical necessity utilizing approved criteria.
Completes the required paperwork for all patients. (IMM, MOON, and Patient Choice)
Completes Discharge Disposition Code.
Documents discharge plan
Documents determinatons/outcomes in financial and case management programs.
BSN or AD from an accredited school of nursing required
Minimum of one year clinical experience. Prior experience in Case Management, Utilization or Discharge Planning preferred.
Current RN license in state of PA required.