MAJOR FUNCTION: 

Facilitates a patient’s hospitalization from pre-admission through discharge. Collaborates with physicians, nurses, social workers and other members of the healthcare continuum to ensure appropriate, cost-effective care. Applies clinical expertise and medical necessity criteria to perform the functions of utilization management, care coordination, resource utilization, and discharge planning. Must utilize established criteria to review appropriateness of admission and continued stay. Perform initial and ongoing assessment to ensure a timely transitional care plan is developed that will support each patient’s needs and prevent hospital readmission. Identify and prevent potential barriers in transition of care. Ensure discharge plan is consistent with patient’s clinical course, continuing care needs, and covered services. Identify patients and/or families who require social work referral. Actively participate in multidisciplinary rounds. Collaborate with ...