Continuum of Care Coordination: Coordinate care plans for patients from acute admission through discharge, serving as the central point of contact for families, physicians, and insurance providers.
Utilization Review (UR): Apply clinical criteria (InterQual or MCG) to perform concurrent and retrospective reviews, ensuring patients are placed in the appropriate status (observation vs. inpatient) and securing necessary insurance authorizations.
Discharge Planning: Evaluate post-acute care needs to build safe discharge pathways, arranging for home health, long-term acute care (LTAC), skilled nursing facilities (SNF), or durable medical equipment (DME).
Length of Stay (LOS) Mitigation: Partner with the interdisciplinary medical team to address social determinants of health, clear clinical barriers, and minimize avoidable days and readmission risks.