FAQ
- I'm still confused about what case management really does.
A:- Assesses, monitors, and evaluates the utilization of resources for optimal patient care
- Ensures appropriate reimbursement by reviewing and documenting patient care which supports the clinical level of care
- Facilitates the continuum of care by coordinating services between physicians, disciplines, payers, and providers in the hospital and community
- What does a typical day look like for you from start to finish?
A: The order depends from person to person but in general we all:- Huddle daily with the charge nurse/team leader, Social Work, Child Life Specialist, and other team members to stay up-to-date on our patients.
- Interview caregivers on all of our new patients as an initial assessment.
- Review our current patients to ensure their hospital stay is still necessary and appropriate and then submit the review to insurance payor.
- Round or otherwise communicate closely with physicians and rest of team to ensure care is being provided appropriately and in a timely manner. Attend weekly multidisciplinary meetings and family meetings as needed.
- Prepare for patients’ discharge by ensuring needs are arranged for: this may include transfer to another care facility, or equipment, supplies, and education for home.
- What’s the difference between a case manager, a discharge planner, and a discharge coordinator?
A:- Case Manager – responsible for assessing patients, coordinating discharge needs, and ensuring hospital stay is necessary and being used efficiently in order to maximize reimbursement. While other organizations may also utilize Social Workers as case managers, at LLUCH a case manager is always an RN.
- Discharge Planner – works with patient, family, and physician on discharge needs under the direction of the case manager
- Discharge Coordinator – facilitates obtaining supplies, services, and authorizations for discharge under the direction of the case manager
- When is a Case Manager available?
A:- Each Children’s Hospital inpatient unit has a designated case manager that is available Monday through Friday for eight hours, typically 8 a.m. to 5 p.m. but may vary earlier or later by an hour.
- Weekend and holiday coverage is provided to the entire Children’s Hospital by one case manager, available by pager #8868, from 8:30 a.m. to 5 p.m.
- Where can I find documentation to see the progress on a patient’s discharge needs?
A: Case Management documents electronically in LLEAP. You can find our documentation under “Case Management” in the “Reports” section. An Intake/Initial Assessment is posted within two business days of admission and a reassessment follows on a weekly basis if the patient remains hospitalized. Progress Notes and Discharge Plan of Care are entered as needed. - Ok, I’m starting to understand what case management is about. So how can I be a contributing member of the team?
A: Understand our role in the patient care continuum and communicate with us daily about your patients’ needs and care updates.
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