Care Management

Care Managment

Care Management monitors all aspects of patient care to assist in the promotion and maintenance of quality care through analysis, review and evaluation of clinical practices in the hospital, and utilization of resources.  Additionally this department collaborates with members of the health team to support patient throughput along the continuum to meet their individual healthcare needs.

The staff assists patients, families and significant others in managing the variety of emotional and social problems that may accompany an illness or injury.  The staff accomplishes this task when fulfilling the following functions:

• Psychosocial assessment, grief counseling, crises intervention, and referral services for additional individualized psychiatric care.
• Discharge planning, including coordinating discharge plans with patient; their families, physicians, nursing and other care providers.  The discharge plans include placement, home health needs, and financial resources management related to health care services and mental health needs.
• Coordinating of assistance for substance abuse and victims of abuse.
• Education, including assisting with patient/family education related to psychosocial, resource needs.
• Community linkage, including development of relationships with the community agencies, providing information and referral services for the members of the community.

Utilization Management

Utilization Managment performs initial and concurrent reviews to assist in monitoring necessity of admission and utilization of hospital resources.  The staff responds to payment denials/questions by outside review agencies and insurance carriers.  The staff performs medical necessity validation and pre-certification for inpatient services and communicates information to commercial carriers and governmental agencies.