Case Management

Sneak Peek: A (controversial) case for ending the marriage between UR and case management

Case Management Weekly, April 25, 2012

Utilization review (UR) and case management are as traditional a team as peanut butter and jelly. But some facilities are asking whether this longtime duo is really the best combination.

In what might be seen as a controversial decision, some facilities are now separating case management and UR.

This is a big change – UR has long been a major part of a case manager’s job description. But Riverside Medical Center in Kankakee, IL, is making the move. Its goal is letting case managers spend more time with patients and be, well, case managers, says Brenda Menard, director of case management at Riverside.

Further, Riverside wanted to allow case managers to not only spend more time with patients, but promote partnerships with their physicians for an efficient assessment of transition of clinical care. The organization now has a full-time certified insurance staff member performing UR, says Menard. Eventually, clinical documentation improvement staff may also be placed on each unit so they too can perform UR functions, she adds.

This article is adapted from an article which originally appeared in the April Case Management Monthly published by HCPro, Inc.


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