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Case Management Utilization

Information

Name *

Last 4 digits of SSN *

Phone *

Email *

Proficiency Scale

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

Setting

Acute Care *

Skilled/LTAC *

MDS Coordinator *

Home Health *

Telephonic *

Workers Compensation *

Insurance *

Managed Care *

Acute Rehab *

CM/UR Software

Interqual *

Milliman *

MIDAS *

Allscripts UR *

Word Processing Software *

Other: Specify *

Regulatory

CMS/Medicare *

HEDIS Measures *

Core Measures *

Medicaid/Medical *

DRG *

ICD 9 Coding *

ICD 10 Coding *

CPT *

Processes

Benefits Eligibility *

Pre-Certification Review *

Review for Admission Criteria *

Identify Appropriate Level of Care *

Review Status During Stay *

Discharge Planning *

Physician Advisor *

Clinical Documentation Improvement *

Needs Assessment/Order DME *

Needs Assessment/Home Health *

Needs Assessment/Hospice *

Needs Assessment/Skilled *

Third Party Authorization Process *

Concurrent Review *

Retrospective Review *

Professional Knowledge and Skills

National Patient Safety Goals *

Age Specific/Population Based Care *

Age Specific Competencies

Infant (Birth - 1 year) *

Preschooler (ages 2-5 years) *

Childhood (ages 6-12 years) *

Adolescents (ages 13-21 years) *

Young Adults (ages 22-39 years) *

Adults (ages 40-64 years) *

Older Adults (ages 65-79 years) *

Elderly (ages 80+ years) *

EMR

Epic *

Cerner *

Eclipsys *

McKesson *

Meditech *

Allscripts *

Other: Specify *

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