Case Management

Case Manager Tips.

Posted on by Dominick Flarey

Starting Care Management

For those wanting to get into the health field for a job, you’re going to find that there are going to be many positions available such as a case manager, care management professional as well as others. If you want to get into something like this, there are a few things to note before signing up with a program.  First off, you’re going to want to make sure that you know what kind of 

exams and tests you’re going to be taken. You’re not going to want to take the wrong tests for your field because you may find down the line that you didn’t need it in the first place. On top of that, also make sure that your school is going to be accredited. If it isn’t, you’ll find that many hospitals and medical centers won’t hire you because you don’t hold the appropriate paperwork. As long as you ask these questions, you’ll find that most of the time you can find the right program to start your career.

The Role Of the Social Worker Case Manager In Health Care Settings

Posted on by Dominick Flarey

Case Management

The role of the social worker case manager in health care settings is basically to assist individuals and families in obtaining the required resources and navigating different systems of social service. Case management or care coordination is not the responsibility of the social

workers alone, but it is a key aspect in the practice of social work. According to the National Association of Social Workers, social worker case managers are specially trained people who coordinate care.

Case Management Role

A social worker case manager handles many functions. Some of the key functions that they handle are the following: Collaborating with patients, their families and doctors and coordinating a care plan. Providing information as regards treatment plans. Arranging for home health services, transportation, etc., after discharge. Helping patients cope with acute, chronic or terminal illnesses such as AIDS, cancer, Alzheimer’s, etc. Setting up conferences between patients, families and doctors. Providing information about spiritual services. If such services are requested by patients, the social worker case manager has to make arrangements for obtaining the same. Collecting and providing information as regards financial assistance as well as community programs which may be of great help to patients once they are discharged. Prioritizing cases assigned to them. Reaching out and assessing the urgent needs of patients. Keeping thorough records for each and every case, including details of every call, visits to the patient’s home and referrals. Maintaining the confidentiality of the patients. Analyzing the mental and physical health of the patients. Counseling patient’s individually and also in group settings. Networking with various external agencies to organize support services according to the needs of the patients. Assisting with paperwork involved in Medicare, insurance and Medicaid.
A social worker case manger must have sufficient knowledge and expertise to work with patients form varied ethnic, economic and cultural backgrounds. They must also develop their skills to handle multidimensional symptom management, bereavement, etc. Their job responsibilities also include enhancement of quality of life and promotion of well-being of patients, caregivers and families.
In general, the practice is to assign one social worker to one patient in order to ensure care continuity. The social worker care manager must strive to build a relationship with the patient and his/her support system and assist in the identified areas of need. Typically, most health care settings keep a social worker on-call to meet the urgent requirements of patients and families.
In order to work as a social worker case manager, it is important that an individual possess a bachelor’s or graduate degree in social work. A bachelor’s degree in psychology or sociology is also accepted by some employers as it will ensure that he/she has acquired the knowledge, skill and experience to function as a social worker case manger. Some hospitals may require the prospective candidates for the position of social worker case manger to have a master’s degree in social work. This is because the master’s degree prepares students to perform clinical assessments. Certificates obtained after successfully completing the programs offered by the American Academy of Case Management show potential employers that the holder of the certificate has the knowledge and skill to do the job well. All states require those working as case mangers to hold a relevant certification or license. In most states, it is essential for candidates to have a minimum of 3,000 hours of supervised experience in order to obtain the license.

Core Functions

The National Association of Social Workers defines the core functions of the social worker case manger as follows: Engagement,Assessment,Planning,Coordination,Advocacy,Evaluation, and Disengagement.
For instance, a social worker case manager working in a hospital with an elderly patient may meet the patient and assess the need for providing meals-on-wheels to him/her. The case manger will then make the required phone calls to organize the service for the patient, advocate for restrictions on diet and then follow up to ensure that the service is provided to the patient.
Summarizing, the services of social worker case managers are essential in a number of health care facilities that include clinics, retirement homes, hospitals and rehabilitation centers. In fact, the role of the social worker case manager is crucial for the smooth operation of many health care facilities. Professional organizations like the National Association of Social Workers provide ample opportunities through networking efforts.

Case Management and Helping Families

Posted on by Dominick Flarey

I have pretty much always known what I wanted to do with my life and I never. At first I wanted to get into social services and help get children out of abusive homes and bad situations and the like. Then I realized I had need to get more personal with these people. To really affect and have a positive impact on their every day lives after incidents like these occurred. That is  

when I started studying to become a case worker. Getting your case manager certification is not an easy task, but with a little research and some good old fashioned studying, you won’t have a problem. Some psychological classes are involved but they were not really anything I have not been through before. All in all, getting my certification was a fulfilling experience that I will never regret, and now, because of it, I have the job of my dreams! I am one of few people who would not turn back time if given the chance.

Being a Case Manager

Posted on by Dominick Flarey

  A case manager is the person that handles the business portion of healthcare for a patient. This person is a trained professional that oversees the care on every level, for a patient. They coordinate the care provided by many different 

professionals to be sure the plan is safe and effective for the patient. They also communicate with insurance companies or employers to make sure the care that is provided is cover and for how long. In general, they balance patient advocacy with cost containment. Case manager certification processes can differ depending on the school they attend. Most certification programs require certification as a registered nurse, practical nurse, social worker or physical therapist. Case manager certification also requires training in developing and maintaining relationships. They need to be able to coordinate between the client, medical professionals and payees. They also need knowledge in disease management, health care management, psychological and developmental treatment. Most states require certification that can be obtained in as little as six weeks. Case manager certification requires a written exam and internship, as well as continued education to be certain they are up to date on changing regulations.

What a Good Nurse Case Manager Does.

Posted on by Dominick Flarey

Good health care can be a very important thing to have. One of the best ways to make money is to get a job in the health care field. Due to the nature of the work it can be very hard to find a job in the health care field. If you want to be a doctor or nurse then you are going to have to undergo the proper schooling. One great way to obtain your nurses license is to attend an online course. Many doctors have to take a pledge stating that they will act ethically in all situations. In the future the demand for nurses is going to be very great. Many elderly people need assistance with their day to day living. One good way to make money is to become a nurse case manager. A case manager can help assemble all the important details about your health problem. A nurse also knows how to administer emergency help to patients who are in need. It can take one or two years to train a good nurse.

nurse case manager
A nurse case manager is an asset to the healthcare field.

Becoming a Nurse Case Manager and the Need for Training

Posted on by Dominick Flarey

Becoming a nurse case manager can be an exciting role to take in the health care field, giving you a strong role within the organizations that you take employment with. These positions can

involve a great range of functions and various responsibilities, from coordinating patient files and cases, while managing the process of care and the actions that are taken within each case. Altogether there is a great deal to take on in the field, but it is all a very rewarding combination of a role, compensation, and personal benefits. Nursing case management has to start with the right training structure that will ensure you really grasp the important concepts of the career and are able to remain proficient within the field. This training should take place in the atmosphere that is going to best perform for you, providing you with a stable education base for starting a very pleasing career.

Organizing Medical Case Management

Posted on by Dominick Flarey

In the medical field, many people can be involved in your health care and recovery. It can get confusing trying to figure out who to talk to about what. Case management has made that easier. The case manager is the person responsible for assessment, planning, facilitation, care

coordination, evaluation and advocacy for options and services to meet and individuals and family’s comprehensive health needs. The do their job through communication and available resources to provide quality cost effective outcomes. They plan, seek and monitor services for different social agencies and staff on behalf of the client. The do this in four steps. First, they get the referral of a new patient. The case manager then develops a plan for delivery of care. They evaluate the results for each patient and make adjustments where needed. Finally, they evaluate the overall program effectiveness. They function in several different areas. In the health care and HMO setting, their duties may include checking benefits and negotiating rates along with many other duties. In the health care provider setting, they will verify original benefits, coordinate services and provide post care follow-up but that is just a taste of their duties in that area. In the employee setting, they verify medical reasoning, follow-up after work absences and provide health education.

Purpose of Case Management and Case Management Plans

Posted on by Dominick Flarey

One of the main purposes of case management is to help the patient with improving the quality

of their lives. It is a process by which a social service agency’s worker is assigned and can assist the patients and their families in connecting with the resources needed for their health care needs and helping them to navigate through the social service systems. Their role is to advocate on behalf of their patients and assist other medical providers with understanding the needs of the patient. With a good case manager handling the case, the collaborative process is made much easier because the patient’s voice and their decisions is the essential key. In order for the case manager to properly execute the required services, they will have to create a plan that will guide them and their patients through the overall process. One of the first steps in this planning process is meeting with the patient.

CASE MANAGEMENT in NURSING

Posted on by Dominick Flarey

Case Management in nursing is an evolving practice specialty. The role of nurses in case management is to supervise and coordinate healthcare for patients with long-term illnesses. Such patients require long-term therapy and careful planning of all aspects of treatment. For instance if there is a patient suffering from cancer , the nurse who is assigned the role of the nurse case manager must arrange for doctor’s appointment, drugs, radiation, surgery or chemotherapy. A nurse case manager usually works in a specific practice specialty such as cancer, pediatric or cardiovascular disease.
Among the goals of case management nursing is to coordinate the care of patients. Since there are other specialists involved such as therapists, surgeons and other doctors, a nurse in case management will coordinate and keep the records of all their activity while updating the patient accordingly on the progress. According to the health problem at hand, the nurse can also decide what the other specialists should examine the patient so that there is collaboration of efforts by all. The nurse also ensures that all the procedures performed on a patient are at the highest level, increasing the chances of the expected outcome. In so doing, all the resources are used efficiently without any wasted or over usage of care resources.

Case Management in Nursing

The role of the nurse in case management can be defined in 3 basic ways, or a combination of any, according to the individual hospital setting as follows:

Quality Management

In larger hospitals, this aspect of quality management may be separated from the normal case management. The nurse is assigned the role of ensuring that all the services provided are of high standards. In smaller hospitals though, the finances may not allow for separation of duties and the case management nurse does all the work involved. The nurse is responsible for the general quality of health care being delivered, and can also assist in the risk management office when legal matters arise during a patient’s treatment.

Utilization Review

This type of case managers review different elements of the various hospital systems, guided by the terms of the hospital or the insurance company that is in charge. Prompt service delivery as well as adequate and safe utilization of the service is also a responsibility under this docket. The nurse is specially of essence in relation to insurance, because he/she approves and certifies acute and non-acute admissions. This information is then passed on to the insurance company under which the patient is covered. The nurse uses what is known as ‘InterQual Criteria’ which is a standardized method of identifying diagnoses, probable complications, procedures required and the timelines during which to account for a shifting diagnoses.
The Utilization Review nurse coordinates with the quality manager physician to administer high quality services to the patient. For instance if the patient has improved and no longer needs acute care, the nurse can consult the QM physician to see if the patient can be transferred to outpatient care or other suitable services. Before making a decision, the physician will review the patient’s chart, current situation and discharge plan. If in agreement the recovering patient can be moved to a lower level of care. To qualify for a post of Utilization Review Manager nurse, a three-year experience in  an acute hospital setting is advisable.

Discharge Planning

The role of this nurse in case management is to coordinates all the elements of admission or discharge of a patient. According to the InterQual Criteria, this nurse deals with the high risk patients with chronic diagnoses such as complicated pneumonia or stroke. The nurse combines all the available social and financial services to come up with a viable and safe discharge plan. A discharge planning nurse can cover up to forty patients at a time depending on the individual hospital policy. It is ideal however to have no more than twenty patients. Past experience together with assessment abilities are used to review the patients current situation, medical history and family support before formulating a discharge plan. A discharge planner should be familiar with Medicare guidelines, InterQual Criteria as well as fees for service items that enable a patient to be given a different level of care. These are some of the important things that should be known.
Nursing case management is a growing practice specialty. Many registered nurses are taking advanced case and care management programs to increase their knowledge and skills to practice in this area. As health care continues to reform, we will see this nursing specialty increase in demand and in importance.

American Academy of Case Management

Posted on by Dominick Flarey

Nurse Discussing Records With Senior Female Patient During Home VisitThank you for visiting our AIHCP web blog. This category of the blog focuses on the specialty practice of Case Management. Our blog provides our visitors and professional members and students an ever expanding platform for related articles, information, discussions, event announcements and much more. We invite your participation by posting comments, information, sharing and authoring for our blog. Please visit us often and be sure to book mark us!