When the placement agency called and said it was looking for an interim case management director in Alaska, and asked if she was interested, Randi Ferrare, RN, BSN, hesitated for just a moment.
At many hospitals the terms Utilization Management (UM) and Utilization Review (UR) are used interchangeably. Are they the same thing? No, they're not, according to Stefani Daniels, RN, MSNA, ACM, CMAC, and Ronald L. Hirsch, MD, FACP, CHCQM.
Case management in Alaska isn't for the faint of heart, according to Randi Ferrare, RN, BSN, interim director of case management and social work at Providence Alaska Medical Center. Some of the challenges force case managers at Providence Alaska to work a little harder and get a little more creative to meet the needs of its patient population. One innovative program at the hospital is its case management educator position.
Many hospitals have added case managers to their EDs, but these case managers face unique situations. CMM experts answer questions about how to handle these issues.
Whether it's a precautionary CT scan that may not really be needed or a duplicate laboratory test ordered by separate physicians, many hospitalized patients are getting unnecessary tests, and experts say it's a big problem.
More and more hospitals are choosing to become part of Accountable Care Organizations (ACO) in an effort to streamline patient care and reduce costs. If your organization is considering joining an ACO, you may have questions about how these groups work and how the change might affect your job. CMM asked several experts for the lowdown on what the transition to an ACO might mean for case managers.
