Utilization Management And Discharge Planning

713 Words3 Pages
At Lexington Medical Center they have separate departments that handle Case Management which is referred to as Utilization Management/Discharge Planning, and Risk Management. Quality Management is used everywhere throughout each department in every position to maintain ongoing quality. Best Practices is a whole department that focuses on Quality Management for clinical practices. Utilization Management/ Discharge Planning/ Case Management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, and cost-effective outcomes. At LMC Utilization Management consists of RN’s, and licensed Social Workers. Utilization Management works with the HIM department on ensuring that any documented clinical practices were physically done. Being an advocate for the patient Utilization Management works to get all procedures and/or medications pre-approved by their insurance company before the treatment is received to lessen any financial strain on the patient or eaten cost for the hospital. Utilization Management also does Discharge planning. Discharge planning has many angles that must be looked at for certain patients. Some patients may have trouble paying for medications which means they will not take them and they will just end up back in the hospital. They may not be able to take care of themselves, or be able to get to follow up appointments. At LMC the Utilization Management team will do everything ethically they can to ensure the patients safety after being discharged from the hospital. Being transferred to a nursing facility ... ... middle of paper ... ...gain access. Report are ran and monitored by Information Security to determine if all accesses to locked records were appropriate. See example (14.1). Quality Management ensures that an organization, product or service is consistent. It has four main components: quality planning, quality assurance quality control, and quality improvement. At LMC quality Management is utilized throughout the facility to maintain an ongoing quality maintenance plan. The main Quality Management department for clinical practices is Best Practices. In the HIM department the positions of The Coding Quality Manager and Quality Analysists have quality in their job titles but everyone in the HIM department contributes to Quality Management it is a group effort and that is why the HIM department runs efficient. Refer to objective five for descriptions of each HIM employee’s title.
Open Document