Case Management & Discharge Planning

UM nurses review inpatient cases daily: applying InterQual or MCG criteria to determine medical necessity for continued stay, coordinating with attending physicians on discharge planning, identifying patients who no longer meet inpatient criteria (and facilitating transition to observation, SNF, home health, or outpatient), and documenting the clinical rationale for each continued stay day. You manage the appeal process when a payer denies continued stay. LOS management directly impacts hospital finances (DRG (Diagnosis-Related Group)-based reimbursement doesn't increase with extra days), patient throughput, and quality metrics (excess days are associated with complications).

You round on your unit's census every morning and work out who is going home, when, and what has to happen first. Each patient carries barriers — a pending consult, a family meeting that hasn't happened, home oxygen that needs authorizing, a guardianship question nobody has started. You track them on a worklist or a whiteboard, escalate the ones that are stuck, and record avoidable days when the delay wasn't clinical. Length of stay is the number leadership watches; the barriers are what actually move it.

When a patient needs skilled nursing, home health, inpatient rehab or hospice after discharge, you assemble the clinical packet and send it to facilities. Then you wait. Facilities screen for whether they can manage the patient's clinical needs, whether the insurance will pay, and whether they have a bed tonight. You chase acceptances, re-send when nobody bites, and walk the patient and family through a choice they are making under time pressure from a list of names they do not recognize.

You work out which discharged patients are most likely to come back, and you make the handoff hold: medication reconciliation done, follow-up appointment booked, the primary care office told what happened, the patient able to explain their own plan in their own words. Some of this is a formal transitions-of-care program. Some of it is a phone call two days out that catches the person who never filled the prescription.