Case Manager-Inpatient-Acute Observation

Applies Case Management principals in coordinating patient care across the continuum using assessment , care planning, implementation , coordination, monitoring and evaluation for cost effective and quality outcomes in a primarily inpatient setting, including complex discharge planning . Performs Utilization Management clinical review to ensure that services rendered to members meet clinical criteria and are delivered in the appropriate setting. Utilizes clinical skills and knowledge to coordinate, document and communicate all aspects of the utilization/benefit management program. Performs care review both prospectively and retrospectively. Identifies members with complex conditions requiring one on one case management and/or disease management services and refers appropriately to the Presbyterian Integrated Care Management program.