Case Manager

Case Manager

All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHIs vision to be among the kindest, highest quality health systems in the country. In collaboration with providers, screen patients to identify and support the delivery of the most appropriate level of care and service.

Collaborates with Physicians, Nurses, Social Workers, and other hospital departments as necessary, to facilitate the improvement in the quality of care and/or the efficiency with which hospital services are utilized. Ensures the active involvement of the patient and or family in the evaluation process and provides assistance with planning and arranging post hospital services. Identifies appropriate community resources for each assigned patient and works collaboratively with patients, families, multidisciplinary team members and community agencies to achieve desired patient outcomes. Ensures initial implementation of the discharge plan and appropriate education regarding discharge plan to patient and family to facilitate a safe transition of care from the hospital to home or another facility. Performs Utilization Review (UR) to determine medical necessity for admission, continued stay, appropriate utilization of resources and level of care determination based upon MCG criteria. Communicates medical necessity information with the requesting Payers, as per KHI policies and procedures. In conjunction with the Discharge Care Coordinator, determines whether required post discharge services are covered by the patients payer and informs patient of coverage determination.