Case Manager

Job description

1. Reviews admissions (physician orders, emergency room documentation, diagnostic test) for admission status based on approved utilization management criteria sets. 2. Uses Interqual effectively in all admissions and concurrent reviews. 3. Confers with the admissions department and/or emergency room staff regarding admission status (in-patient vs observation) of patient as necessary. 4. Conducts admission, concurrent, and discharge review for insurers and other agencies in order to obtain authorization and length of stay assignment when require. Does this in time frame designated by each insurance, keeps up to date on each insurance requirements. 5. Performs admission review and discharge screening within 24 hours of admission as outlined in the Case Management plan, screens on a daily basis all new patient admissions to identify patients in potential need of comprehensive discharge planning . 6. Familiarizes self with assigned patients medical history, keeps track of major sequence of event in current hospitalization and knows the anticipated DRG, length of stay, and transfer and/or discharge date. 7. Completes the assessment within 72 hours of admission for each patient. Completi...