No sound on this presentation Care Management Team RN Case Managers Social Workers Utilization RNs Scope of Services Care Management team collaborates with the patient families physicians nursing and other ancillary services to provide coordinated care for our patients ID: 935584
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Slide1
Care Management Department
No sound on this presentation.
Slide2Care Management Team
RN Case Managers
Social Workers
Utilization RNs
Slide3Scope of Services
Care Management team collaborates with the patient, families, physicians, nursing and other ancillary services to provide coordinated care for our patients.
Slide4Hours of Operations
Case Managers/UR RNs
M-F 8 a.m. - 4:30 p.m.
S-S 8 a.m. - 4:30 p.m.
ED Case Manager
M-F 8 a.m.- 8:30 p.m.
S-S 8
a.m
- 6:30 p.m.
Social Workers
M-F 8 a.m. – 4:30 p.m.
S-S 8 a.m.-4:30 p.m.
** Note hours and availability may differ depending on market
Slide5Case Managers
Review and assess 100% of admissions
Screen for discharge needs and barriers
Coordinate referrals to Home Health, Hospice, higher level of care transfers, Skilled nursing facility transfer, LTACH transfers
Coordinate medication assistance, outpatient IV therapy, wound care
Assist with discharge transportation, DME
Collaborate with Social Worker for complex social needs
Coordinate Care Conferences
Slide6Social Workers
See patients on consultation basis
DSS application/ T19 application assistance
Guardianship assistance
Complex psychosocial needs
Collaborate with the Care Manager on referrals identified and placed by the CM
Slide7Utilization Review-RNs
Commercial Insurances
Note-Provider offices responsible to obtain
priorauth
for elective admissions
UR-RNs-Complete concurrent authorization for emergent admissions.
UR-RNs-Obtain certification of level of care and days authorized for the hospitalization
Slide8Utilization Review-RNs Continued
MEDICARE and other government payers
Reviewed utilizing the guidelines provided by each of these payers
Cases not meeting those guidelines are referred for Physician Advisor assessment
Outsourced Physician Advisor utilized is some cases
Slide9Inpatient or Observation ?
All cases reviewed for medical necessity based on Medicare Guidelines
CMS 2 midnight rule followed
Delays related to tests/procedures-tracked by Utilization Review Committee
Inpatient/Observation orders-must be validated by physician with admitting privileges.
Role of AHP-Can enter orders for admit, however, these will need co-signature by physician.
Slide10Confirmation Number
You have completed this training. Please return this confirmation number to the Medical Staff office.
355158