Services in:
The Hospital


The hospital can present many challenges. The care manager will provide assistance in support and education related to the medical diagnosis. As professionals, we have a good working knowledge of the predicted outcomes of acute or chronic conditions. The care manager will review the medical record and speak with the nurses and doctors in charge of your care to assist in meeting Medicare criteria for discharge planning. Perhaps the most important part of the care coordination is working with the discharge planner to provide timely information on discharge plans. The care manager will further enhance your choices and facilitate assistance in finding the location of your preference at the time of discharge.

Services Include:

  • Provide professional oversight of care
  • Interface with specialists to obtain test results or review treatment plans.
  • Collaboration with hospital discharge planner to select preferred care community
  • Help facilitate the 72-hour stay for potential Medicare-covered rehabilitation
  • Review discharge plans to ensure medical equipment is provided if needed to appropriate setting, medications are ordered, therapy is addressed and further medical appointments are identified.