CM extenders work in off-site center
Referral specialists are assigned to clinical teams
At the University of Wisconsin Hospital and Clinics, the case management support team is in an off-site Resource Center.
The Resource Center is staffed by payer specialists and referral specialists who take care of the nonclinical details often assigned to case managers.
Payer specialists are assigned by payers and review companies and typically make 60 to 70 telephone calls a day, taking care of clinical review requirements. Case managers enter the clinical review information into the case management software, where the payer specialists can access it.
"This has freed up the clinical staff to work within their team, rather than have the case manager or social worker on the telephone on hold for 20 minutes. Now they conduct their clinical review and the payer specialist gets it to the insurance company," says Barbara Liegel, RN, MSN, director of coordinated care. Her department includes case management, social work, utilization review, and discharge planning.
Referral specialists are assigned to clinical teams and take care of the day-to-day details the team delegates.
For instance, they check out patients’ insurance to determine what durable medical equipment or home health care the company allows, set up transportation, and check the availability of nursing home beds.
"There is a lot of work that supports discharge planning, but you don’t need a licensed professional to handle faxing, copying, and telephoning. It all can be done by a support person," Liegel says.
The department has been able to decrease the number of support positions by moving them offsite and centralizing them, rather than being on site and working with the teams, she adds.
(For more information, contact:
- Jamie Zachary: [email protected]; Angela Roberson: [email protected]; Steve Blau: [email protected]; Barbara Liegel: [email protected].)
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