Supervises the day-to-day operation of Case Management/Utilization Review RESPONSIBILITIES: Provides leadership to establish a comprehensive utilization review/management function that integrates effective patient activities across the continuum of care. Oversees the planning, implementation and ongoing evaluation of utilization review nurses and clinical evaluation of care coordination nurses Responsible for coordinating those systems necessary for utilization management practices that meet all corporate, facility and regulatory guidelines Collaborates with physicians, nurses, and all caregivers to assure a team approach to care across the continuum. Responsible for the reporting of reliable information about the treatment and flow of patients throughout all levels of care. Establishes strong working relationships with the Physician Advisors. Monitors individual patient Length of Stay (LOS), identifies outliers, and works with Care Coordination Team and Physicians to expedite discharge. Acts as liaison to payer community to maximize reimbursement and relations. Assures staff competency by providing professional development opportunities. Demonstrates a commitment to providing excellent customer service by responding to customer requests in a prompt, courteous and compassionate manner. Responsible for weekend reports and staff oversight.
Maryland Psychological Association (MPA) is the statewide professional association for Maryland psychologists, supporting the psychologists in Maryland in advancing the science and practice of psychology for the health and welfare of the public. MPA educates about psychology and mental health, and promotes psychological science and practice. Find a local psychologist with our free referral service.