Care Coordination: Assess, plan, implement, and evaluate coordinated healthcare options for patients; ensure efficient resource utilization and cross-department collaboration from admission through discharge.
Utilization Review (UR): Conduct concurrent and retrospective reviews using InterQual or Milliman Care Guidelines (MCG) to secure insurance authorizations and validate appropriate levels of patient care.
Discharge Planning: Proactively formulate individual safe discharge plans, arranging for home health services, durable medical equipment (DME), or transfers to skilled nursing/rehabilitation facilities.
Interdisciplinary Leadership: Lead daily multidisciplinary rounds alongside physicians, social workers, and physical therapists to minimize patient length of stay (LOS) and avoid readmission penalties.