Hours: 8AM - 8PM
JOB SUMMARY
Practices with minimum supervision from another licensed professional and is able to perform the following components of care management according to the Case Management Society of America Standards: assessment, facilitating, planning, advocating,, monitoring, evaluation, and outcomes. In collaboration with all healthcare professionals involved, this position is also able to demonstrate the above components within the following core activities: coordination and service delivery, physical and psychological factors, benefit systems, cost benefit systems, cost benefit analysis, care management concepts and community resources.
The URS facilitates communication and coordinates between all members of the healthcare team involving the patient and family in the decision-making process in order to minimize the fragmentation of the healthcare delivery system.
The URS Â is a leader in effecting change to improve the quality of patient care and reduce the cost of services on a care by care basis, as applicable.
The URS understands financial implications of care in today’s healthcare environment such as (but not limited to): requirements for prior approval by payer; cares which would benefit from alternative care; analysis of necessary medical services for cost containment; healthcare plans for appropriateness; home health/hospice resources; healthcare delivery systems; DRG system; care mix index; managed care and capitation.
The URS responsibilities also include facilitating the admission process for non-elective, emergency inpatient admissions and outpatient observation stays; monitoring observation stays at the end of 23 hours for possible inpatient admission or discharge planning; ensuring that all patients are screened against Interqual or other appropriate criteria and assist the physician in identifying alternative methods of care when criteria are not met. Works closely with the Physician Advisor on cares that do not meet admission criteria or continued stay criteria. Provides simple discharge planning services, such as Home Health and DME referrals and makes referrals to social workers for complex discharge planning. The URS, Complex NCM, CM Screener and PARCC will work in collaboration as a team, to ensure timely provision of services. . The URCS will assist in program development and implementation for specific programs and plans of patient care such as clinical pathway, population specific and disease management initiatives.
The URS will review an average patient care load of 25 patients per day, utilizing InterQual review criteria for medical necessity.
The URS will work closely with the UM Specialist/Analyst to ensure cost-effective care and appropriate utilization of services are delivered based on the patient’s individualized needs, providing the appropriate level of care.
