Downtime Process
The URCM will manually enter an InterQual review in a Documentation noted and send IPAS referrals using...
What is Message Center
(All Day): Mortality Notification, CC44, IPO
OBS/OPB Admission and CS Reviews
IP Admission Reviews from Yesterday
NICU Admission Reviews
What is Tier 1
Maternity CS Reviews
All Other CS Reviews
What is Tier 3
Conduct a retro Episode Day 1 (ED1) review
Follow appropriate IP URPG
NICU/SCN cases will need retro review, including AC level, for all days not completed
What is Inpatient PSO
Verify the procedure listed on the R1 email is the procedure completed
What is Confirm IPO Procedure
URCM caseloads are typically following a period of Interqual downtime or Holiday are often ............ from the typical UR workload.
What is Increased
Proactive Care Model Reviews: PEHP, SelectHealth CS
URPG-1 and URPG-2 CS Reviews
URPG-3 CS Reviews
What is Tier 3
(All Day): Mortality Notification, CC44, IPO
OBS/OPB Admission and Daily OBS Reviews
IP Admission Reviews from Yesterday
NICU Reviews (Admission and CS)
What is Tier 1
Follow appropriate OBS/OPB URPG
If pt is admitted before 1530 on prior day, a retro ED1 IP review is required
-If meets IP criteria and patient is NOT DCing, pursue an IP PSO
-If patient does not meet IP and is NOT DCing, follow URPG and refer to IPAS when 2MN confirmed. Request determination for both ED1, Current day reviewing
Planned IP Procedure, Panned TKA or THA, Planned or Unplanned OPB, "Inpatient Only", Vag Delivery, Planned or Unplanned C-Section, General Inpatient Hospice, Organ Donation, Planned Chemo, SH Products, OP Overflow from OP Areas, Unable to Complete, None
What is a UR Screen
URCMs should follow established ............ to organize the workload when it is anticipated the workload will not be completed.
IP Admissions from today (Gov then Commercial)
BHU Verbal CS Auths
DCd Patients w/o Required InterQual Review
NICU CS Reviews
What is Tier 2
IP Admissions from Today (Gov then Commercial)
Weekend Follow Up (UM Status Marked 'Weekend')
DCd Patients without Required InterQual Review
What is Tier 2
Deep breathing techiniques, meditation, calming music, quiet environment
What is Calm Down
URCM should seek answers to questions by engaging with a peer, mentor, or TL within respective Region Teams chats. Then TL will coordinate with another TL to address and resolve the issue. TL will escalate to UR Manager if needed.