Medical Case Management:

Three-point contact assessments, initial in-person evaluations with client, ongoing medical management services, limited assignments, and follow-up.

Coordinate catastrophic case management as needed, includes in-hospital patient evaluation, obtaining diagnosis, condition, plan of treatment, and physicians.  Includes ongoing medical case management services.  Discharge planning to coordinate transportation to the patient's home and physician appointments, home health coordination, coordination of prescription medication, delivery, and DME.

Evaluate the patient in the hospital in catastrophic cases/emergencies.  The nurse will conduct an initial assessment, obtain patient's condition, diagnosis, physician's plan of treatment, and report to the referral source for additional instructions.

Pre-certification is performed on a surgical or diagnostic procedure to determine whether:
   The procedure is appropriate to the diagnosis;
   The level of service is appropriates to the diagnosis; and
   The length of stay is appropriate to the diagnosis.

Medical necessity information is requested on the proposed procedure.  Diagnostic and medical records are obtained.  Consistent follow-up with the proposed procedure is continued until the patient is discharged.
On approved procedures, a pre-cert number is provided on a letter sent to the physician and hospital facility.  If certification for the procedure cannot be approved, this is stated in a letter sent to the physician and hospital facility.

Life care planning along with catastrophic care coordination promotes continuity of care and effective appropriation of services.

The case manager will conduct a detailed home evaluation, ascertaining what ADL's the patient is able to do and with what they will need assistance.  The evaluation form will be completed by the case manager and reviewed by the treating physician for their approval and signature.