Case Management Specialist

Job Summary:

Continuously evaluates the quality, care, treatment and outcomes of complex patient populations. Collaborates with the patient/family and caregivers to facilitate necessary resources and options for post‐discharge services to support a safe discharge. Provides consultation with physicians and other members of the interdisciplinary healthcare team to facilitate patient progression to discharge. Ensures clinical documentation supports medical necessity criteria and meets regulatory requirements. Communicates the clinical status of patients related to medical necessity criteria to the physician advisor (internal or external) and/or the Inpatient Care Transitions leadership team as needed. Monitors length of stay and documents avoidable days for delay of discharge. Reviews payer source for potential negative financial liabilities to the patient.