MCMC > Directory > Departments > Case Management

Case Management

Thank you for visiting the Case Management department page. We are available Monday - Friday 7:00 am to 3:30 pm, Saturday 7:00 am to 12:00 pm. We are staffed with 4 full time employees. We are here to develop discharge plan for patients, perform utilization review functions, and provide assistance based on patient's needs.

Patient Care

We communicate with all observation and inpatients to assess needs and follow up after discharge, if needed.

Responsibilities and Purpose

The Case Management department is here to evaluate patients on admission and throughout their hospital stay for any discharge needs. Our utilization review coordinator reviews charts and communicates and reports to insurance companies for admission and continued stay criteria. Furthermore, our Care Coordinator maintains the transitions of care and chronic care management programs.

Services Provided

Case Management:

Conducts reviews on all admissions for the severity of illness, appropriate utilization of services, and appropriate designation of “inpatient” or “observation” status.
Begins to plan for discharge on admission and/or the first indication that the patient may have continuing health problems after discharge.
Makes referrals to long-term care, acute rehab, geri-psych, substance abuse, hospice, and home health.
Arranges and orders DME and home respiratory supplies.
Makes rounds daily with physicians to aid in identifying patient’s post-hospital needs and to encourage timely and appropriate use of hospital services.
Conducts patient and family education that will enhance recovery and transition to the next level of care.

Utilization Review:

Reviews patient charts for admission criteria and continued stay criteria and relays information to insurance companies.
Communicates with insurance companies for pre-certifications and authorizations for admissions as well as outpatient procedures.
Enters date for Joint Commission and the Center for Medicare and Medicaid Services.

Care Coordination:

Organizes and directs the preventative medication programs located at the physician practices.
Quality champion for the physician practices.
Responsible for quality reporting to Center for Medicare and Medicaid Services.
Practice Improvement
Promoting Interoperability
Oversees the prescription assistance program.
Oversees the vaccine registry program.

Contact Information

For more information or if you have questions or concerns, please contact us:

Donna Murray
RN, Case Manager
(270) 487-9231 ext 1175
Tracy Murphy
RN, Case Manager
(270) 487-9231 ext 1170
Dana Hammer
Utilization Review Coordinator
(270) 487-9231 ext 1172