UPMC
Care Manager (RN), ED/ICU (Harrisburg)
UPMC, Harrisburg, Pennsylvania, us, 17124
The Care Manager (CM) coordinates the clinical and financial plan for patients. Performs overall utilization management, resource management, discharge planning and post-acute care referrals and authorizations. Works with a multi-disciplinary team in resource management, discharge planning, and care facilitation.Daily Hours:
Monday - Friday, 1:00 p.m. to 9:30 p.m. No weekends or holidays.This position is eligible for a generous sign-on bonus.Responsibilities:Reviews medical record daily to ensure patient continues to meet LOC requirements and that chart documentation supports LOC determination. Works with Physician Advisor and Attending Physicians to obtain necessary documentation to support current LOC, alters LOC as needed, and expedites discharge planning for patients who no longer require hospital services.Collaborates with patients, caregivers, internal/external healthcare providers, agencies, and payers to plan and execute a safe discharge. Re-evaluates and revises discharge plan as patient clinical condition merits. Develops alternative/multiple discharge plans in anticipation of patient need for post-acute services. Uses InterQual criteria to justify appropriate LOC (Skilled, Rehab, Home Care, DME, etc.) and obtain all necessary payer authorizations for post-acute care. Documents Freedom of Choice re: post-acute services.Serves as a resource to clinical and finance teams for clinical documentation requirements, level of care, insurance coverage issues, specific payer and government policies, and post-acute services coverage and availability.Attends Department meetings and Corporate Care Management Training sessions to maintain current knowledge of all payer and regulatory requirements, UPMC CM policies and procedures, and community resources. Ensures compliance with all payer and government regulations.Promotes patient safety. Supports CORE measures information for JCAHO requirements.Takes a leadership role in the concurrent denial process. Works with Care Management Director, Physician Advisor, Attending Physicians, and clinical team to obtain necessary information and documentation to support LOC. Initiates acceptance of lower LOC when appropriate with assistance from the billing office. Obtains Consent to Appeal on Behalf of Member on all cases with concurrent denial.Starts discharge planning on admission and ensures DC documentation is completed and updated regularly. Proactively identifies barriers to discharge and works with the multi-disciplinary team to expedite care, monitor length of stay (LOS), and facilitate discharge. Addresses complex clinical and social situations efficiently to avoid unnecessary delays in discharge. Documents all Avoidable Days in the CANOPY system.Performs clinical review on admission and/or continued stay using InterQual criteria to determine appropriate level of care (Inpatient, OBS, etc.). Obtains all necessary authorizations for level of care including admission and continued stay. Follows payer-specific requirements to obtain and document authorizations.
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Monday - Friday, 1:00 p.m. to 9:30 p.m. No weekends or holidays.This position is eligible for a generous sign-on bonus.Responsibilities:Reviews medical record daily to ensure patient continues to meet LOC requirements and that chart documentation supports LOC determination. Works with Physician Advisor and Attending Physicians to obtain necessary documentation to support current LOC, alters LOC as needed, and expedites discharge planning for patients who no longer require hospital services.Collaborates with patients, caregivers, internal/external healthcare providers, agencies, and payers to plan and execute a safe discharge. Re-evaluates and revises discharge plan as patient clinical condition merits. Develops alternative/multiple discharge plans in anticipation of patient need for post-acute services. Uses InterQual criteria to justify appropriate LOC (Skilled, Rehab, Home Care, DME, etc.) and obtain all necessary payer authorizations for post-acute care. Documents Freedom of Choice re: post-acute services.Serves as a resource to clinical and finance teams for clinical documentation requirements, level of care, insurance coverage issues, specific payer and government policies, and post-acute services coverage and availability.Attends Department meetings and Corporate Care Management Training sessions to maintain current knowledge of all payer and regulatory requirements, UPMC CM policies and procedures, and community resources. Ensures compliance with all payer and government regulations.Promotes patient safety. Supports CORE measures information for JCAHO requirements.Takes a leadership role in the concurrent denial process. Works with Care Management Director, Physician Advisor, Attending Physicians, and clinical team to obtain necessary information and documentation to support LOC. Initiates acceptance of lower LOC when appropriate with assistance from the billing office. Obtains Consent to Appeal on Behalf of Member on all cases with concurrent denial.Starts discharge planning on admission and ensures DC documentation is completed and updated regularly. Proactively identifies barriers to discharge and works with the multi-disciplinary team to expedite care, monitor length of stay (LOS), and facilitate discharge. Addresses complex clinical and social situations efficiently to avoid unnecessary delays in discharge. Documents all Avoidable Days in the CANOPY system.Performs clinical review on admission and/or continued stay using InterQual criteria to determine appropriate level of care (Inpatient, OBS, etc.). Obtains all necessary authorizations for level of care including admission and continued stay. Follows payer-specific requirements to obtain and document authorizations.
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