Hospital Case Managers are professionals in the hospital setting who ensure that patients are admitted and transitioned to the appropriate level of care, have an effective plan of care, and receive medically necessary treatment. Our department advocates for the patients and their families to ensure the services and resources needed are in place during their stay and upon discharge.
Our goal as a team is to use discharge planning, social services, and utilization review to ensure the patient and family get their needs met across the continuum of care from admission to discharge. Our team works hard to ensure better patient outcomes, better compliance with medical advice, and better patient self-management. Utilization review involves making sure that a patient is getting care that’s medically necessary and getting it in the correct setting.
The utilization manager assesses the patient’s health insurance plan and works with the insurer, patient and providers to ensure that the best care is delivered with the least financial burden. We have open communication with the patient’s health insurance company. We work closely with insurance companies to make sure they understand what is happening during the patient’s hospitalization by giving them information needed to approve payment and avoid denials. Preauthorization is also done by this team to ensure that procedures and tests are approved before they happen.
Discharge planning starts on admission and is the process of predicting the patients continuing medical needs after the hospital and putting a plan in place to meet those needs. During the discharge planning we arrange for all services needed upon discharge from hospital.
Our social work professionals help individuals, couples and families cope with the social , psychological, cultural and medical issues resulting from an illness. They also help our patients fully utilize medical care and services. We offer specialized care for patients receiving services in OB, Touchstone, Emergency department, Inpatient Care and Skilled Care. Assuring that our patients’ medically related emotional and social needs are met and maintained throughout their medical treatment is our highest priority.
Our team will be there to explain your healthcare resources and policies. They will also help with discharge needs by arranging for services at another facility, coordinate additional care, schedule visits in your own home, or help you or your family receive the needed follow-up care. We refer patients to community resources that may benefit them, help them with advanced directives and other long-term care needs. Having a good relationship with the patient and family is important to be able to communicate any updates or changes in patient condition.