Utilization Care Management
The Care Management team is comprised of 7 Registered Nurse Care Managers, 1 Registered Nurse Denial Coordinator, 1 Administrative Secretary and a Care Management/Denial Supervisor. The Nurse Care Manager monitors patient plans of care for timely completion and efficient use of resources by facilitating diagnostic and treatment services, tests, consultations and procedures. The Care Manager oversees appropriateness of care using pre-established, health industry standards insuring the appropriate allocation and use of hospital resources. She also facilitates patient flow during the inpatient stay and identifies and proactively addresses potential denials of payment.
The Denial Management portion of the Utilization/Care Management team has been extremely successful in keeping the adjusted inpatient hospital denials at a minimum. These Registered Nurses work diligently with the nursing and medical staff, as well as the payers, to develop appeals to clinical denials to assure full inpatient day approval and appropriate reimbursement. The clinical expertise of the RN denial coordinators and care management staff has been instrumental in recovering over $5.6 million dollars in denied charges since the inception of the denial management program began four years ago.
This team includes:
- Lisa Adkins, RN, MSN,CPN,CPNP; Care Management/Denial Supervisor
- Joanne Dispenziere, RN, BSN, CCM; Care Manager
- Marylou Lawlor, RN, BSN, CRRN; Care Manager
- Nancy Jaeger,RN, CCM; Care Manager
- Valerie Bica, RN, BSN, CPN; Care Manager
- Laurie Murray, RN, BSN; Care Manager
- Beverly Garner, RN, BSN; Care Manager
- Anita Zeccola, RN, BSN; Denials Coordinator
- Sherrill Dougherty, RN; Denials Coordinator
- Dorothy Pisano; Administrative Secretary
- Each staff member will have a positive, professional attitude toward fellow staff, patients/families, physicians and payors.
- We will offer and accept both praise and constructive criticism in a positive manner, always attempting to improve our work.
- Gossip is unacceptable in our office.
- We will treat each other with respect by resolving conflicts in a private, non- threatening manner. We will seek to resolve conflicts no matter whose problem or fault. If unable to resolve the conflict, we will seek assistance to obtain a resolution.
- We will discuss our concerns about attitude, work performance, etc in a professional non-threatening manner directly with the person involved.
- We will offer assistance daily to fellow staff whenever finished with our own assignment before leaving for the day.
- We will arrive on time, ready to work each day.
- We will greet each other each morning, interacting cordially with our colleagues every day.
- We will eagerly educate other staff whenever possible.
- We will strive to build and sustain a culture of trust by showing pride in our work, respect for each other, credibility through our actions and fairness in all interactions.
VISION:
Freedom from disabling conditions
MISSION:
To provide leadership, institutions, and services to restore and improve the health of children through care and programs not readily available, with one high standard of quality and distinction regardless of the recipient’s financial status.
VALUES:
Respect, Honor, Excel, Serve, Learn
