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.”
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.”
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:
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.”
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.
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