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Clinical Resource Management (CRM)

CRM provides services to all inpatient units (except inpatient psychiatry) with a focus on efficient and effective care coordination, transition planning, patient advocacy, and discharge planning for patients needing post-acute care services such as skilled nursing, rehabilitation, continued therapies, home care, home infusion, private duty nursing, durable medical equipment, and outpatient pharmacy.

CRM identifies high risk, clinically complex, under-insured, or uninsured patients to:
  • Coordinate interdisciplinary family meetings and manage care across medical specialties Lead meetings for the care delivery team as well as legal, finance and leadership representatives
  • Locate community resources for post-acute care needs
  • Negotiate self-pay and charity care across the continuum
  • Advocate for the patient and family
CRM nurse case managers ensure that the hospital receives appropriate reimbursement from public and private payers. They also work with Admissions, attending physician and payer to determine that the appropriate level of care is assigned for each patient. In order to be successful, nurse case managers must be:
  • Clinical experts
  • Adept with standardized utilization management criteria and principles
  • Knowledgeable of healthcare systems and financing
  • Able to analyze clinical and financial data
Additional Notes
  • The majority of CRM nurses are either certified case managers (CCM) or certified professionals in utilization review (CPUR)
  • CRM coordinated the first annual Pediatric Case Management Conference with the Center for Case Management in 2006.
  • CRM established and managed a grant fund to cover home-care services for patients with pending Medicaid, allowing patients to return home when medically appropriate while assuring the home-care vendor of payment if Medicaid is not approved.
  • CRM established the Care Coordination Community with the Child Health Corporation of America (CHCA) in 2007 to share best practices with other CHCA facilities.
 


 
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