Pre-admission, continued stays and discharge planning through hospital episodes of care are the main activities of case management. Case management is conducted when a hospital stay is expected to incur a long length of stay, is a result of a high-risk pregnancy, is related to a transplant or covered clinical trial or is a catastrophic case that has been admitted either instate or out of state. The client is monitored over the entire course of their hospital stay with ongoing communication with the hospital case manager and/or discharge planner. All case management services are telephonic.
Procedures – Mountain-Pacific’s nurse case managers are available to provide suggestions of community/medical/ equipment resources to hospital staff which are conducive in facilitating the hospital discharge. When the hospital admission meets any of the conditions as described above, hospital staff can phone or fax clinical information to Mountain-Pacific, thus providing notification of the need for case management.
Mountain-Pacific staff can be reached at 800-262-1545 or by fax at 800-497-8235.
Process –Mountain-Pacific case managers review clinical documentation to determine medical necessity for hospital admissions and continued hospital stays. For hospitalizations with extended lengths of stay, the case manager communicates with members of the health care team on a frequent basis to determine the anticipated discharge plan. Timely discharge home or to a lower level of care is the optimal goal. Continuing communication with the hospital discharge planner/case manager will continue until a successful discharge plan has been developed and the client is successfully discharged.
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