What Is Case Management?
The definition of case management is the planning, processing, and monitoring of the healthcare services given to a patient by a coordinated group of healthcare providers. Case management is designed to provide for a patient’s needs while controlling costs, with a case manager maintaining information on a patient’s outcomes. Insurance companies, hospitals, and outpatient care providers may assign a case manager to monitor a particular patient.
Case management, sometimes known as dynamic case management, is usually done by professionals in the healthcare field with experience working in a medical setting such as a hospital.
- What is a case manager? The role of a case manager is most often undertaken by registered nurses and social workers.
- Some physicians practice case management on the job.
- The role is defined more by the needs and goals of individual organizations, versus one consistent role model of case management practice.
- Case managers may work for insurance companies and hospitals to ensure costs are kept down for the consumer and the provider.
- A case manager's duties often extend beyond a hospital stay for many patients who need extensive rehabilitation.
How Case Management Works
How do you define case management? There are various ways. For example, a medical professional managing an individual’s needs is not that different from a financial advisor managing a client’s portfolio. Case managers evaluate a patient’s needs and determine how to provide care efficiently given the resources at hand.
Because case managers work for health insurance companies, hospitals, and other providers, they attempt to keep costs down as much as possible. With rising costs in healthcare, case management can be a valuable tool for both consumers and companies alike.
A case manager evaluates what services are considered medically necessary when a new case is started and works with different service providers to ensure that the required services are given in the appropriate setting. Case managers must navigate complex care needs, which may involve different services offered at different times by different healthcare providers.
Hospital case management involves working with insurance companies to ensure that procedures and services fall under the policy coverage and will be paid for. It also involves educating patients on lifestyle adjustments, how to take medication, and when to come in for follow-up appointments. Case management in a rehabilitation center, for example, would use mental health service providers to follow up with patients.
Targeted case management is aimed at a specific group of patients who need ongoing care, such as those with chronic mental health challenges, or disabilities.
Case management does not end when a patient leaves the hospital. Some nurses will visit patients in their homes even after a routine medical procedure like the birth of a child. Insurance companies plan for ongoing medical needs, including further check-ups and outpatient care, to reduce the need for expensive emergency room visits.
By expanding the time frame considered part of the case, medical providers can better catch symptoms early on before they develop into something more serious. Continued interaction with the patient also allows medical professionals to evaluate how well treatments are progressing and change medication and visits as needed.
Types of Case Management Models
Below are three case management models that can be customized or edited to suit the particular needs of a hospital or health organization. These adaptable models may be used in a variety of case management settings for various individuals.
The Strengths-Based Clinical Case Management Model
The strengths-based model is based on the strengths of the client, and takes into account their personal needs, goals, and helps the client incorporate all their strengths (including community, family, friends, and home environment) to create a plan of care.
The Clinical Case Management Model
A clinical case model creates a plan using a combination of services from physical therapy to mental health resources, The case manager using this model works hands-on to ensure the patient is utilizing all therapies, and they meet regularly with the patient to discuss ongoing care.
The Brokerage Case Management Model
This model focuses on the delegation of services to a patient, after an assessment. Case managers using this model provide access to the services needed, but they do not interact frequently with a client, other than put together their rehabilitation plan and schedule. This is a relatively hands-off approach with limited manager interaction versus some of the other models.
Intensive Case Management
Intensive case management is designed to deliver services to a patient quickly with one-on-one meetings with the manager who often accompanies the patient to sessions and appointments to ensure rehabilitation goals are met. Out of all the models, intensive case management gives patients the most individual attention, and case managers are actively involved in the rehabilitation process.
Case Management Certification
In order to earn your case management certification, you must have the qualifications needed in order to be allowed to take the certification exam. In order to take the CCM exam, you must have at least 30% of qualified work time with a focus on case management practice, according to the Commission for Case Manager Certification. In addition, you must have a current, active, and unrestricted licensure or certification in a human services or health area.
Anyone who wants to take the certification exam must have the proper education credentials. For example, you must hold a bachelor or graduate degree in social work, nursing, or another health or human services.
Example of Case Management
River had a terrible bike accident and suffered from a traumatic head injury, along with a broken arm and femur bone. Because their injuries impacted both their physical and cognitive abilities, their life was hard to manage. A clinical case management model was used and the caseworker assigned provided a care plan to ensure treatment ran smoothly.
The case manager signed them up for physical therapy, neuropsychology, and occupational therapy sessions, coordinated appointments, met with them regularly, including check-ins by phone, and offered help navigating all the financial planning. By having steady contact and helping River with their appointments, the caseworker could carefully plot out their recovery plan and provide River with close attention to help them fully recover.
What Is Case Management in Social Work?
Case management in social work is how a professional social worker assesses and assists a client and their family. A social worker may manage a case by conducting home visits, helping a client get enrolled in the social services they need, and by following up with a client and their family after an assessment.
What Is Case Management in Nursing?
Case management in nursing is when a nurse follows up with a patient to make sure they receive the care and rehabilitation needed to make a recovery.
What Is Case Management Software?
Case management software is an online tool used to track patients, cases, appointments, and other items that case managers and their employers need for their files.
What Is Targeted Case Management?
According to the Centers for Medicare & Medicaid Services, targeted case management is specific to assisting special groups, like those with chronic mental health or developmental disabilities, get the services they need.
What Is a Case Manager?
A case manager is usually a nurse, social worker, or healthcare administrator who is trained to assess treatment needs, create and evaluate plans, act as a liaison between clinicians and patients, monitor rehabilitation, review records and applications, and assist new case managers.
The Bottom Line
When it comes to case management there isn't usually a one-size-fits-all approach to the rehabilitation of patients. It is important for case managers to apply different models of case management depending on the injury or illness. By learning how to implement different models of case management, a case manager with a strong background in healthcare will be better suited to serve a wide range of individuals.