Career Center

General Summary

Dual Care Management Role: Under general supervision, provides utilization review and discharge assessment, denials management for an assigned patient assignment. This role utilizes nationally recognized care guidelines/criteria to assess the patient's need for acute inpatient care as well as the appropriate level of care. The role requires interfacing with the Care Management team (RN/SW), medical team, other hospital staff, physician advisors and payers; while also includes assessing, develops, implements, coordinates and monitors care plans for the inpatient/observation population facilitating patient movement throughout the continuum of care to include patient admissions and discharges; both within the treatment facility and into the community. Provides leadership support within the multi-disciplinary teams to achieve quality clinical outcomes.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by staff assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

1. Performs timely and accurate utilization review for all inpatient and OBS admissions using nationally recognized care guidelines/criteria relevant to the payer and documents in the EMR and shares review with the payer for authorization.
2. Performs timely and accurate continued stay reviews for all inpatients using nationally recognized care guidelines/criteria relevant to the payer and documents in the EMR and shares review(s) with payer for continued stay authorization.
3. Communicates with care management team, physician advisor, medical team and payors as needed regarding reviews and pended/denied days and interventions.