Responsible for inpatient medical necessity, appropriateness of care, level of care, and quality of care medical reviews for hospitalized patients in accordance with all state mandated regulations. Coordinates and conducts initial, concurrent, and retrospective medical record reviews. Makes utilization decisions based on InterQual criteria for New Hampshire. Collaborates and communicates with Case Managers and Social Workers to ensure appropriate and timely admissions and discharge planning consistent with the patients continued need for inpatient care.
1. Performs continued review of medical records and identification and need of on-going hospitalization.
2. Obtains and reviews necessary medical reports and subsequent treatment plan requests to conduct reviews and validates physician’s orders, reports progress and unusual occurrences on patients.
3. Ensures cost-effective healthcare services to patients.
4. Analyze patient records, and participate in interdisciplinary collaboration with professional staff. Facilitate educational programs and advises physicians and other departments of regulations affecting utilization management. Consult with various agencies regarding the level of nursing care and collaborates with other departments in evaluation of projects affecting admissions and discharging plans.
5. Performs administrative duties; receives, logs and files a variety of reports, client charts, client interactions and other documentation.
Crotched Mountain Rehabilitation Center - 2 years ago
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