Case Management

Case Managers assess, plan, coordinate, monitor and evaluate options and services required to meet the patient's health needs. At Massachusetts General Hospital, case managers are assigned to inpatient units, primary care physicians’ practices, the Emergency Department and the Admitting Department.

The Mass General Clinical Documentation Reviewer is an experienced registered nurse who manages the hospital’s inpatient clinical documentation improvement program called DRG Assurance. This program focuses on improving the specificity and clarity of physician's medical record documentation to ensure that the medical record accurately reflects the patient’s severity of illness and that MGH receives the appropriate reimbursement. At Mass General, clinical documentation reviewers are assigned to inpatient units. They concurrently review inpatient records and, when indicated, request that physicians further clarify documentation.

Case Managers in the outpatient physician’s practices, are members of the Integrated Care Management Program (iCMP). CMP case managers are experienced registered nurses who work closely with physicians and other health team members to provide care to high-risk, medically complex patients across the continuum. The iCMP Case Manager follows specific enrolled patients to identify their healthcare needs. To ensure that patients are receiving the services they need to achieve an optimum quality of life, the care manager coordinates treatments and providers, facilitates safe transitions between hospital and outpatient settings and educates patients, families and providers on best health practices and services in the outpatient setting.