The Office of Healthcare Compliance & Privacy partners with various units across UConn and UConn Health, promoting a culture of compliance and respect for privacy in healthcare. One of our integral partners is UConn Health’s Case Management Department.  Lori Pawlow, Director of Case Management, shared her insights into how the important work of UConn Health’s Case Management Department contributes to UConn Health’s commitment to compliance.

Case Management professionals guide and coordinate care and services provided to UConn Health patients to ensure that services are provided in accordance with federal and state regulations. Additionally, they assess the patient’s insurance benefits to determine whether services will be covered and inform patients of potential financial liability related to the care they receive. At UConn Health, this team includes RN Case Managers, Social Workers, and Utilization Review professionals.

As Director, Lori enjoys the collaboration with interdisciplinary teams throughout the institution, the connection with finance and billing, and the relationships with patients and their families. According to Lori, Case Management uses different review platforms to determine patient’s eligibility for inpatient and observation status, reviews options for discharge or transition of care with patients and their caregivers, and continually monitors for severity of illness and medical necessity to determine appropriate level of care.

Case Management and Utilization Review must be dynamic and evolutionary to meet the needs of our growing and diverse patient population and ever-changing regulatory guidelines. When there are questions regarding regulatory requirements, the Office of Healthcare Compliance & Privacy acts as a resource to research and provide guidance. The collaboration and rapport between Case Management and the Office of Healthcare Compliance & Privacy make the Case Management department an effective and dependable compliance partner.