UM Corner – August 2012

By Melissa Marshall, MD

The CHCN Utilization Management Department is happy to introduce its newest employee, Grace Moore, APRN-BC, in a new position for our organization, Manager of Care Coordination. Grace comes to CHCN after being with Brown & Toland for seven years; first as an HIV Clinical Specialist and later as a Care Management Supervisor. With her experience, Grace will lead our nurses to become on-site Case Managers at our top utilized hospitals: Summit, Alta Bates, and Highland.

CHCN is in the process of implementing a Care Transitions project, which will focus on the transition of our members from inpatient status back to the health center, by following the components of Re-Engineered Discharge (RED). Our nurses at the hospitals will educate patients about their diagnosis during their hospital stay, make appointments for clinician follow-up and post-discharge testing, confirm the patients’ Medication Plan, and ultimately, empower patients to be more active in their healthcare.

Placing nurses at the hospitals will not only complete our UM delegated responsibility of inpatient concurrent review, but will also complete Care Transitions work through the Project RED model. Once our new nursing presence is established in the hospitals and the program is fully implemented, clinics can expect to receive more timely information on their discharged patients. We’re excited to have Grace with our team as we venture into this new direction in helping our health centers deliver better coordinated patient care.