Manajemen Pelayanan Pasien merupakan peran yang dijalankan oleh case manager, agar tercipta pelayanan yang bermutu dengan biaya yang efisien. Penelitian ini bertujuan untuk mengevaluasi peran case manager terhadap kendali mutu dan kendali biaya pasien rawat inap bedah dengan penjaminan JKN di RS UI tahun 2022. Penelitian menggunakan pendekatan sistem menurut Donabedian dan teori KARS. Kendali mutu dilihat dari LOS, tingkat kepuasan pasien, kepatuhan penerapan clinical pathway, kepatuhan visit dokter, serta penundaan operasi elektif. Kendali biaya dilihat dari selisih klaim dan tagihan RS dan formulasi biaya tindakan. Pada penelitian ini, data kuantitatif diambil dari data sekunder melalui data rekam medis pasien, hasil telaah dokumen dari berkas tagihan pasien, tarif INA-CBG’s, data laporan operasi, dan data Komite Mutu Rumah Sakit. Data diolah dengan Ms. Excel dan didapatkan tiga (3) tindakan terbanyak yaitu odontektomi, SC, dan AV shunt. Studi kualitatif, dilakukan dengan Focus Group Discussion untuk mendapatkan formulasi pembiayaan tindakan dan wawancara mendalam. Didapatkan hasil peran case manager di RS UI sudah mengalami perbaikan dibandingkan tahun 2021, kinerja case manager sudah baik berdasarkan selisih klaim, pengendalian LOS, tingkat kepuasan pasien, tingkat kepatuhan visit dokter, dan tingkat kepatuhan terhadap clinical pathway. Hanya tingkat penundaan operasi elektif di RS UI masih belum tercapai target.

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Patient Service Management is carried out by case manager to create quality services with efficient cost. This study aims to evaluate the role of case managers on quality and cost control of surgical inpatients with JKN assurance at the UI Hospital in 2022. This study uses the concept of Donabedian and KARS theory. Quality control is seen from LOS, patient satisfaction, compliance clinical pathway, compliance doctor visits, and delays in elective surgery. Cost control is seen from the difference between INA-CBG's claims and hospital bills and cost formulations. Secondary data were collected from medical record and document review. The data were processed with Ms. Excel. The three common                                                       procedures conducted with FGD and interviews to find out the role of case managers. It was found that the role of the case manager at UI Hospital had improved compared to 2021. Case manager's performance is good based on the difference in overall surgical patient klaims, LOS control, the level of patient satisfaction, the level of compliance with doctor visits , the level of compliance with the clinical pathway. Only the level of delay in elective surgery at UI Hospital has not reached the target.