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Case Management and Utilization Review

Redesign Case Management Care Models to Meet Modern Standards and Future Needs

Soyring Consulting experts in Case Management rely on data, interviews, and observations to evaluate Case Management and Utilization Review (UR) processes within the facility or the system. During the assessment, the team evaluates the following areas for process improvement opportunities:

  • Organizational structure and leadership
  • Case/Care management model
  • Hours of service
  • Staffing/Scheduling in comparison to benchmarks
  • Operational process review
    • Regulatory compliance
    • Observation/Inpatient status
    • “Two-Midnight Rule” processes/documentation
    • Admission Status orders
    • RAC internal monitoring processes
    • Clinical appeals policy and process
    • Program for Evaluating Payment
    • Patterns Electronic Report (PEPPER) reports
    • UR Committee reports/minutes
  • On-site operational process observations and review
    • Admitting practices
    • Case management screening processes, medical necessity authorization, and reauthorizations
    • Discharge planning processes to meet Condition of Participation requirements
    • Case review processes “Barriers to Discharge” processes
    • Patient documentation – admission orders, estimated time patient will require inpatient services, continued medical necessity
    • Clinical documentation of specialists’ roles/responsibilities
    • Payer mix and payer-driven methodologies of authorization and re-authorization

 

“The Soyring consultant worked very hard in a difficult environment to initiate change with the hospital. It was refreshing to have a director who knew where they were going and where they needed to eventually be. Kudos!”

PEDIATRIC MEDICAL DIRECTOR, MAJOR HOSPITAL

Learn How Our Experienced Team Can Improve Case Management at Your Hospital or Healthcare Facility.

Contact us today at 1.866.345.3887 or simply fill out this form & we will contact you.