Case Management

Transforming the elective precertification process

Case Management Monthly, November 1, 2008

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The corporate care management staff at the University of Pittsburgh Medical Center (UPMC) knew its system of using nonclinical staff members to review plans for elective surgical admissions begged for restructuring. Communication was poor, LOS was up, and denials were difficult and time-consuming to appeal.

Laura D’Andrea, RN, BS, manager of prearrival nurse liaisons for the corporate care department at UPMC, says it all came down to communication.

Even in a best-case scenario, nonclinical staff members lacked the expertise required to determine whether there were gaps in the documentation that needed to be addressed.

 

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Case Management Monthly.

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