Case Manager-Inpatient-Acute Observation

The Case Manager-Inpatient-Acute Observation role involves coordinating patient care using case management principles across the continuum. Responsibilities include assessment, care planning, implementation, coordination, monitoring, and evaluation to achieve cost-effective and quality outcomes, primarily in an inpatient setting. The role also encompasses utilization management clinical review to ensure services meet clinical criteria and are delivered appropriately. Documentation and communication of utilization/benefit management aspects are essential, involving prospective and retrospective care review. The Case Manager identifies members needing complex case management, referring them to the Presbyterian Integrated Care Management program, and collaborates with healthcare teams to develop and implement treatment and discharge plans. This role also applies utilization review criteria to assess the appropriateness of admissions, continued stays, and discharge readiness, escalating cases not meeting criteria to a Physician Advisor.