Case Management
| Telephone |
443-444-3860 |
| Location |
5th floor, hospital |
| Hours |
weekdays: |
Available to patients daily to address care coordination, utilization management and discharge planning issues.
As a member of the multidisciplinary team, the case management department monitors and coordinates quality care to patients and families through appropriate resources management. Case Management coordinates services across the continuum of care to facilitate quality and cost-effective treatment in the most appropriate setting. Case Managers and Social Workers provide care coordination, discharge planning, and utilization review to assist patients with their return to the community.
Case Management Services
- Coordination of care via collaboration with other professionals to maintain highest standard care
- Discharge planning services are provided as needed, which may include:
- Long-term care placement
- Sub-acute, transitional placement
- Rehabilitation placement
- Home health services
- Community referrals arrangement
- Durable medical equipment arrangements
- Coordination of transportation for patients
- Identification of system failures and intervention to improved patient movement through the health care system
- Facilitation of patient/family adjustment with acceptance of diagnosis, impending disability and/or treatment
- Clinical assessment to assure alternative care option lead to improvement of patient's medical/health status
- Consideration of patient's financial resources to assure reimbursement of care delivered
- Facilitate team conferences and care coordination rounds
- Pre-Admission assessment and education for planned orthopedic procedures
- Coordination of specialty programs (HIV/AIDS, Renal, Ortho, Cardiac, Rehab) across continuum
- Management of quality and continuity issues with nursing homes
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Utilization Management Services
- Concurrent review with all contracted insurers is conducted daily by phone, fax or with the on-site reviewer from the insurance or managed care company in order to optimize reimbursement and management of the patient's care
- Utilization review and monitoring for quality problems are provided for all patient admissions and continued stays
- Pre-admission review is conducted daily for the following patients:
- Planned medical admissions
- Admissions for elective surgery
- Transfers from other acute care facilities
- Data tracking from delays in service, length of stay denied, and appealed days
- Appeal of denied days as appropriate after clinical review of medical record
Social Work Activities
- Clinical assessment of the psychosocial, spiritual and cultural values that impact the patient's response to care
- Counseling and intervention to the patient and family to maximize the patient's quality of life during and following hospitalization
- Identify gaps of service
- Liaison with community services
- Collaborate with other professionals to maintain the highest level of care.
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