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Our Services |
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As part of our clinical case management services, we:
- Collaborate with patients, families and the health care team to promote comprehensive care for inpatients and timely access to internal health care resources and support services
- Facilitate linkage to on-site liaisons from payers, community health agencies and government agencies
- Provide case management consultation to inpatient clinicians and, on a limited basis, to clinicians in our ambulatory clinics and day surgical programs
- Coordinate discharge planning activities for hospitalized and emergency room patients. This begins upon admission and prior to admission, when necessary and possible. To promote quality discharge plans, we:
- Assess services and/or resources that may be needed to support the family's ability to care for the child at home
- Collaborate with patients, families and clinicians to develop plans for safe and appropriate discharges. This may include conversations with families, clinicians and community providers prior to admission to anticipate needs.
- Coordinate referrals, as appropriate, for community health services, rehabilitation, and skilled nursing facilities.
- Negotiate with insurers and other funding sources for coverage of services, equipment, medications and supplies necessary for post-hospitalization care
- Initiate referrals for available case management services by payer organizations, government agencies and community providers
- Provide information and referrals for additional community resources through such organizations as Department of Public Health, Early Intervention Programs and other support agencies.
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As part of our utilization management services, we:
- Provide clinical updates to insurance companies for all hospitalized children
- Collaborate with physicians to assign level of care for hospital care and services
- Work with clinicians and discharge planning case managers to facilitate safe and timely discharges or transfers to other care settings
- Provide clinical consultation to the Patient Financial Services at Children's as needed for pre-approval of medically necessary and appropriate services, tests, procedures and hospitalizations at Children's
- Collaborate and consult with administrative departments and clinical support staff to maximize timely and appropriate access to Children's clinicians and services
- Assist in appeals of payer coverage denials and referrals to government assistance organizations.
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- Contribute to clinical program development, research, and quality improvement activities at Children's
- Collaborate with payer organizations to facilitate patient and family access to benefits and to maximize coverage of medically-necessary care
- Organize and participate in educational programs and publications for clinicians, patients and families, and community providers
- Advocate for and support development of community services and resources for children and families to achieve their health care goals.
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