(718) 963-7271 or (718) 963-7159
Mission Statement:
Our mission at Wyckoff Heights Medical Center’s Case Management Department is to return people to their optimum level of health in a timely and cost effective manner. The Case Managers will communicate with the patients, physicians, families and payer sources in order to furnish a customized plan seeking the most appropriate medical care while ensuring the integrity of our services and those of our caregivers.
Utilization Management a division of the Case Management Department is responsible for monitoring clinical and financial outcomes of patient care utilizing pre-established guidelines and criteria. The department takes appropriate follow-up activities where established criteria are not met. The UM/QM Nurses are also the liaison to all insurers and have daily phone and fax contact with the various insurance companies to justify admission, continued stay and to assure payment. Areas to be monitored are determined by management staff considering diagnostic groupings, focus of care, and volume. The UM/QM Nurses are assigned to specific units and provide back-up to one another as scheduled by management. The UM/QM Nurses are also responsible for retrospective reviews and special projects to assist in Performance Improvement measures.
The Denials Management Division of the Utilization Management Department is responsible for appeals management, scheduling and preparing reports for quarterly Utilization Management Committee meetings, participating in Performance Improvement projects as assigned. The director of Case Management / Utilization Management is also the IPRO liaison and is responsible for coordination of responses to IPRO quality of care concerns and the dissemination of data received from IPRO to the clinical departments and support services with in the institution.