Scope of Work



Under general direction, integrates cost, quality and utilization to facilitate the admission, continued stay and discharge of the patient. Reviews and evaluates appropriateness of admission or continued stay based on medical necessity. The overall goal of the position is to enhance the quality of patient care and engagement, to promote continuity of care and cost effectiveness through the integration and functions of utilization management, and/or care coordination, discharge planning, and appropriate care transitions. Has accountability for the care coordination and discharge planning of all hospitalized patients.



+ Identifies patients that need care management services (i.e. utilization review; care coordination; and/or discharge/transition planning).

+ Responsible for managing a case load of patients that includes facilitating utilization management, and/or care coordination during the patient’s stay, planning and exp...