Case Manager

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Under the direction of the Director and or the Operations Manager of Case Management performs Utilization Review and Discharge Planning for assigned patients.

Analyzes medical record for medical necessity, level of care and appropriate utilization of hospital services.

Provides assistance to patients and their family in planning discharge and after care of patients.

Assesses needs, identifies resources to support discharge requirements and develops formal discharge plans


* Uses knowledge and skills to ensure a high degree of continuity of care.


* Refers all cases, which fail to meet utilization screening criteria to physician reviewers.


* Determines and monitors appropriate length of stay.


* In collaboration with hospital personnel, manages care delivery.


* Screens all patients for potential discharge needs.


* Initiates discharge planning and facilitates discharge teaching.


* Identifies resources for follow-up care and evaluate effectiveness of discharge planning.

NICU Specific Specifications:


* Participates in direct patient care by ensuring appropriate discharge information for each NICU infant.


* Ensure that each infant discharged from the NICU have a follow-up by a primary care physician and provide when appropriate follow-up care in a specialized program for the High Risk Infant.

Determine if infant meets high risk for follow-up criteria and advise parent/guardian of process.

Make appointments at specialty clinics for infant.


* Identify discharge needs at admission and arrange for any durable medical equipment the physician has ordered.


* Ensure that each infant discharged has the opportunity to be seen by a Home Health Agency Nurse following discharge.

• Referral to CCS when infant meets qualifying criteria.

Instruct parent/guardian on CCS referral process.


* Under direction of the Director of Case Management, develops and implements discharge planning standards of care for the neonatal unit.


* Pursues new knowledge in neonatal discharge planning by reviewing and evaluating current literature, attending and/or presenting at conferences in order to maintain a high level of expertise.

Pediatric Specific Duties:


* Participates in direct patient care by ensuring appropriate discharge information for each pediatric patient.


* Ensures communication with appropriate primary care physician and community agencies as well as when appropriate with.


* CCS programs; identification and appropriate referrals


* CCS Special Care Centers o Regional Centers whose care includes the needs of the infant, child or adolescent post acute hospital discharge.


* Ensures provision of a written discharge information that is culturally and linguistically appropriate be given to the parent, legal guardian, and or primary care...