The Case Management Department is located in the nursing unit. Two RN Case Managers evaluate patients on admission and throughout their acute care stay for transitional/discharge planning needs. This can include referrals to acute rehab units, long-term care or geripsych facilities, home health, or hospice; arranging for durable medical and respiratory care equipment / services; and addressing patient / family concerns and questions in one on one conferencing.
The department is also staffed by an Utilization Review Coordinator / Data Abstrator who is located in the Nursing Administration office suite. Utilization Review is responsible for pre-certification and insurance coordination. The Utilization Review Coordinator reviews charts for admissions and continued stay criteria and communicates this information to various insurance carriers and payors. Utilization Review Coordinator also conducts reviews of quality data for Joint Commission and the Center for Medicare and Medicaid Services.