CAI provides an experienced, on-site management team to facilitate the implementation of the case management strategy. The team is comprised of a CAI Senior Project Leader, and a Solutions Lead staffed by one of our Senior Medical Directors.
The implementation activities typically include the following:
Program Design and Focus
Based on the results of the comprehensive assessment, CAI works with the Hospital's management team to implement the care management strategy that aligns with overall hospital goals and objectives. The program fundamentals, such as, the use of data to set the focus, the necessary clinical support, the potential reallocation of staff and the development of the program measurement tools are defined and developed.
Staff Training and Development
Using the results of the chart audit and staff assessment, CAI develops a prescriptive learning plan designed to enhance the care management skills of the nursing and medical review staff. Our training programs are designed to increase productivity, improve interdisciplinary care management team outcomes, enhance and promote quality patient care that will result in a positive hospital bottom line impact. Effective care managers require skills such as level of care assessment, UM review techniques, proactive management, referral to physician review, discharge planning, effective benefits management, reimbursement analysis, resource allocation and cost-benefit analysis. CAI provides training modules that address all of the above.
For the hospital physician reviewers, CAI can provide a customized training program that is focused on improving the review process and outcomes. This training is provided by a CAI Senior Medical Director with extensive experience in the training of physicians in utilization and case management. This training addresses topics such as the art of utilization review, dealing with the issues of peer-to-peer review, the effective use of levels of care in the review process and an overview of regulatory requirements.
Provider Network Outreach
CAI will assist the hospital in developing a provider advisory process to review and address hospital staff practice pattern variations that contribute to higher costs and issues of quality. This committee can also be used to develop program guidelines, and case management strategies.
Physician Review Appeals Proxy
CAI can provide Physician Review Appeals Proxy services. This program serves to supplement the Hospital's physician review function. The CAI Physician Review Appeals Proxy services upgrade the opportunities for a successful appeal, identify areas of improvement and mitigate adverse provider issues.
All CAI nurses and board certified physician reviewers are credentialed and trained in the most current care management and managed care principles and practices
and have access to the most current clinical information and practices. CAI assures quality control of our physician review process through evaluation of inter-reviewer reliability, productivity assessments and results analysis and is in compliance with NCQA and URAC requirements related to these processes. In addition, we follow all HIPAA regulations related to business associates.
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