/
Care Management Department Care Management Department

Care Management Department - PowerPoint Presentation

Thrillseeker
Thrillseeker . @Thrillseeker
Follow
342 views
Uploaded On 2022-08-04

Care Management Department - PPT Presentation

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

rns care review social care rns social review utilization physician case admissions coordinate assistance guidelines cases workers managers management

Share:

Link:

Embed:

Download Presentation from below link

Download Presentation The PPT/PDF document "Care Management Department" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

Care Management Department

No sound on this presentation.

Slide2

Care Management Team

RN Case Managers

Social Workers

Utilization RNs

Slide3

Scope of Services

Care Management team collaborates with the patient, families, physicians, nursing and other ancillary services to provide coordinated care for our patients.

Slide4

Hours 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

Slide5

Case 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

Slide6

Social 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

Slide7

Utilization 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

Slide8

Utilization 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

Slide9

Inpatient 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.

Slide10

Confirmation Number

You have completed this training. Please return this confirmation number to the Medical Staff office.

355158