Manage patient cases with a high degree of clinical knowledge and expertise.
Requirements
- Assure that patients meet care criteria from admission through discharge.
- Initiate authorization with network providers.
- Maintain knowledge of clinical information for patient’s stay by review of documentation, participate in staffing, attend care conferences and collaborate with other members of the treatment team.
- Perform concurrent review with network providers; monitor medical record documentation using knowledge of established guidelines to promote compliance and further ensure quality for retrospective review by external review entities
- Liaison with physician and other treatment team members to assure that all aspects of treatment are fully documented.
- Lead the flow of information between levels of care by collaborating with the admissions department, clinical and financial departments, and the patient and their family/guardian throughout program to provide a smooth transition at discharge.
- Coordinate resources with other community services and agencies. Discuss appropriateness of a continued stay or continued care by the facility with the multi-disciplinary team, third-party case managers, physicians and other departments.
- Perform other functions and tasks as assigned.
