The Utilization/Care Management team reviews each inpatient and observation admission daily to assess the medical necessity of the hospital stay. The Care Management Registered Nurses work collaboratively with the rest of the patient care team and the insurance company to assure that each hospitalization meets the appropriate level of care and is reimbursed correctly.
Learn more about Who We Are
How to Reach Us
- Phone: (302) 651-4492
- Fax: (302) 651-6029
Care Management/ Utilization Review
- Monitor inpatient admissions for timely completion and efficient use of resources.
- Review appropriateness of care using pre-established health industry standards, ensuring the appropriate allocation and use of hospital resources.
- Meet daily with nursing, medical team, and social work to coordinate care.
- Serve as a liaison between providers and insurance companies.
- Identify and proactively addresses barriers and potential denials of payment.
Insurance Denial Management
- Develop appeals to clinical denials to assure full inpatient day approval and appropriate reimbursement.
- Collaborate with hospital billing to appeal post-discharge inpatient denials.
- Assist providers with insurance issues.