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Quality Manager formerly known as abaqis®

Mitigate risk and elevate your quality of care. Improving both clinical and business outcomes starts with a smarter, more integrated approach to regulatory training, continuing education and quality management.

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What Skills Are Best for Healthcare Case Management?

April 1, 2021
April 1, 2021

According to the Case Management Society of America, “Case Management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost effective outcomes.” Nurse Journal adds to that description, offering that a professional in this position “oversees the monitoring of long-term care plans for patients of different backgrounds. These nurses typically work with a specific type of patient who requires constant, ongoing medical care. Patients can include geriatrics, cancer patients, and individuals with HIV. Case management nurses work with other medical professionals to cultivate effective long-term care plans to ensure patients receive the highest quality of healthcare available.”

What Case Managers Do

Case managers oversee everything that happens to patients from the moment of admission, throughout treatment, and up to discharge from a hospital or another healthcare facility. These professionals provide guidance for the long-term care of patients, which includes decision-making about any important treatment options.

Nurse case managers cooperate and collaborate with varied teams of medical professionals to facilitate comprehensive care plans that are tailored to individual patients' histories of medical treatment and illness. According to Nurse Journal, “These professionals research the most modern procedures and treatments for their nursing specialty, overseeing treatment plans and updating them whenever necessary. Nurse case managers schedule surgeries and arrange doctor's appointments for patients and monitor their medication usage. Additionally, these nurses educate patients and their caregivers about the different resources and treatment options available to them.”

About Certified Case Managers

According to study.com, many certified case managers generally hold a bachelor's degree in nursing, psychology, counseling, or other relevant areas. Some can have a master's degree in health, human or education services or a related field, while others may complement an associate's degree in health or human services with a registered nurse license. It is common for case managers to intern in their field before working full-time or pursuing certification. Typically, certified case managers should have foundational knowledge of social work principles and procedures to do their jobs.

Important Case Management Skills

HealthStream partner HCPro has identified the following skills that are needed to be an effective case manager. Many of these are critical to successful case management:

  • Clinical Experience and Knowledge – A clinical background and experience are vital to understand the care a treatment a patient needs and is receiving.
  • Communication – Case managers must communicate effectively with their patients and every healthcare professional involved in care.
  • Time management – Time is of the essence when it comes to healthcare, and case managers have many competing responsibilities. Getting everything done is vital when a patient’s life is at stake.
  • Decision-making and problem-solving – Case managers have to be decisive as well as resourceful about finding ways to eliminate roadblocks to care.
  • Organizational – Too many details are involved in patients’ healthcare for the person in charge to be disorganized.
  • Autonomy – A case manager has to be comfortable with working alone and making choices without a backup. Time and urgency especially may not allow consultations with others.
  • Conflict resolution – Acting in the best interests of a patient can lead to conflicts with others in healthcare. Not only must case managers stand their ground, but they need to find a way to turn conflict into collaboration.
  • Teamwork – Healthcare typically involves a team of professionals. The case manager must be skilled at working with others.
  • Delegation – part of using time wisely and being effective is allowing others to take control, provide care, and take action.
  • Political savvy – Effective case managers understand how to go about their jobs without causing hard feelings and bruising colleagues’ egos. This skill is especially important for getting things done.
  • Tolerance – Case management is guided by the principle that all people deserve effective healthcare. Identity and cultural differences have no impact on this responsibility. For example, nurses who work with patients in HIV case management must be understanding of the cultural stigma of HIV and AIDS when conducting their duties, and work to quell any potential intolerance in the medical facility for the comfort of the patient.
  • Commitment – Ensuring excellent patient care has to be the guiding principle and motivation for every decision and action in case management.
  • Role modeling – A case manager should embody the seriousness of his/her mission at all times.
  • Teaching – In everything a case manager does, there’s an opportunity to teach someone why –patients, colleagues, and other care professionals need to learn what drives great care.
  • Cultural sensitivity – A patient may be culturally different from the case manager. This fact in no way changes the patient’s need for effective, often life-enhancing care.

According to HCPro, “It is difficult to prioritize these skills, and they may all come into play at various times for effective case managers. Case managers must consider that on any given day they may need to call on many of these skills in order to effectively accomplish their job. It is the combination of these skills and the flexibility of the individual carrying them out that will make the difference.”

Case Management Training

With the Affordable Care Act changing reimbursement models, case managers must ensure quality care for their patients, provide effective communication to their patients and patients’ families, and coordinate physician documentation within medical records.  They also have to understand and provide guidance on correct patient status, assist with medical necessity denial management, reduce readmissions, and overcome discharge barriers.

Decisions made and actions carried out by case managers affect the quality of patient care and organizations’ reimbursement, therefore implementing a training program is imperative to the success of your organization. Our solution was developed by experts to provide essential case management training that addresses key care coordination issues and mitigate financial and compliance risk.