The primary focus of this position is to oversee and coordinate the discharge planning and utilization management activities for assigned caseload.
The Director of Case Management, using established guidelines, performs on-site assessments and utilization review for assigned caseload to facilitate appropriate utilization of resources and efficient patient progression through the continuum of health care resulting in the highest quality and most cost-effective care. The Director of Case Management understands, effectively communicates, and ensures conformity to payer’s requirements. The Director of Case Management identifies, plans, coordinates, and implements high quality, cost-effective alternatives to more costly care, when appropriate to the patient’s condition. The Director of Case Management supports physician decision-making, and works collaboratively with all members of the health care team, the patient, the patient’s family, and internal and external customers to achieve optimal patient outcomes.
The UM Coordinator collects, aggregates, and reports all utilization and quality data to the Performance Improvement Committee.