**Description**

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Summary:

+ The Case Manager coordinates the hospital’s utilization review activities. Completes CQI Monitors for RM Committee and assures compliance with Federal, State and Third Party Insurance guidelines. Coordinates discharge planning, patient teaching and other associated activities for discharge to nursing facilities or successful community re-entry

Responsibilities:

+ 1. **Monitors UR activities/resource utilization** a. Reviews for appropriateness of admission and continued stayb. Obtains patient precertification to prevent possible payor denialsc. Appropriately follows through with Payor Denials with appeal processd. Confers with physician and/or refers to physician consultant when “Medical necessity” for admission or continued stay is questioned<...