The CDR is responsible for identifying immediate and ongoing needs of the patient and planning a course of care which includes measurable goals with the patient, provider, family, caregivers, and payers. In addition, the CDR will review medical records to facilitate the accurate representation of the severity of illness.

Establishes collaborative and effective working relationships with physicians, nursing, and other staff.

Applies standardized criteria to all admissions to determine the appropriateness of admission and level of care.

Assures the medical record contains objective data to support admission and level of care.

Initiates a case management plan and discharge planning activities at time of admission review and updates it based on patient progress and needs.

In consultation with the physician establishes a targeted discharge date at the time of the admission review (estimated length of stay (ELOS)). Documents and communicates this information to the patient, family and care team. Monitors progress with this plan daily.

Uses clinical knowledge and defined standards of care to proactively identify inappropriate resource consumption and discusses with attending physician. Refers appropriate cases to physician advisor for review.

Understands third party payers current contractual agreements. Completes and communicates admission and concurrent review information to third party payers. Documents all payer contacts and denials.

Identifies and refers patients for social work assessment and intervention as needed.

Collects variance data at time of occurrence (i.e. avoidable days, delays) for use by the department and the organization.

Participates in denial management processes.

Provides notice of termination of benefits (TOB) and level of care changes (LOC) to individual patients/representatives on a timely basis.

Participates in multi-disciplinary rounds on a regularly scheduled basis.

Skills

Required

Required

Required