Case Management In Healthcare

"Case Management in Health Care" is a comprehensive reference designed to educate nurses and other health care professionals on the processes involved in case management. This reference discusses interventions and collaboration efforts that are necessary to move the patient through the continuum of care. It explores the changes in case management and it explains the financial, legal, and service aspects of this field. It is appropriate for nursing students (undergraduate and graduate) as well as for practicing case managers. • Focuses on the most current topics that are based on the changes and trends in case management and health care. • Addresses health care policies, laws and regulations as they apply to a case manager's day-to-day responsibilities. • Presents the basics on health insurance and the alternate funding programs equipping case managers to become active advocates for their patients. • Explores the pitfalls and barriers frequently encountered when locating appropriate patient resources, and explains how to overcome them. • Discusses various levels of care and treatment settings outside the acute care setting (ex. skilled nursing facility and home health care). • Explains the increasing number of case management models that are being used in various clinical settings. • Compares the roles and responsibilities of a utilization manager and a case manager, emphasizing the need for their collective efforts in providing quality patient care. • Case Management and Technology, focuses on systems support, technology tools and resources, meaningful reporting, using the Internet, and video conferencing in relation to effectively serving patients. • Quality Management for Case Managers, covers guidelines for quality management, organization standards and practices, accountability, increasing customer satisfaction, and measuring utilization and costs. • Audits, identifies auditing entities and discusses development of successful competency programs to meet regulatory standards specific to case management. • The Importance of Credentialing, discusses the significance of credentialing as the start of the quality process of an organization. • Discusses new modalities for case management such as demand management, care management, drug state management, and disability management. • Addresses the complexity of the moral and ethical issues facing today's case managers. • Includes content on worker's compensation, on-site vs. telephonic case management, and tools to improve the case management practice. • Tips and training tools for care givers are updated to include agencies, literature, and various web sites dedicated to care giving. • Expanded content on legal and legislative issues such as the Balanced Budget Act (BBA), Emergency Medical Treatment and Active Labor Act (EMTALA), and Health Insurance Portability and Accountability Act (HIPPA). • Provides current coverage of funding and insurance programs such as Medicare, Medicaid, Children's health coverage, Veteran's benefits, and TRICARE. • Content in Complex Care and Post Acute Care units have been expanded to include the latest advances in emergency care, hospice, and managing geriatric, transplant, mentally ill patients. • Each chapter begins with Objectives that list key points and focus the reader on essential content to better prepare them for learning. • Suggested Websites and Resources listed at the end of chapter provide reader with opportunity for further study and research. • End of Chapter Exercises (1-5 questions) promote active learning and application of pertinent content.

Written by case managers for case managers, this reference manual for nurses and other health professionals presents a CMSA tested approach towards systematically integrating physical and mental health case management principles and assessment tools. Since the health care field has undergone major changes such as the passing of the Patient Protection and Affordable Care Act, Mental Health Parity, Transition of Care & Chronic Care Management and the Medicare Act and CHIP Authorization Act (MACRA), health care workers must competently know how to integrate those new regulations, describe alternative payment options, and implement requirements for greater patient and family assessment, care planning, and care coordination in their practice. CMSA’s Integrated Case Management delves into the role of the case manager and unpacks how case managers assess and treat complex patients. These are patients who may be challenged with medical and behavioral conditions, poor access to care services, as well as chronic illnesses and disabilities, and require multidisciplinary care to regain health and function. With a wealth of information on regulatory requirements, new models of care, integration of services, digital and telemedicine, and new performance measures that are clearly defined for nurses in nursing terminology, chapters outline the steps needed to begin, implement, and use the interventions of the Integrated Case Management approach. All content aligns with the newly revised 2017 Model Care Act, CMSA Standards of Practice 2016 as well as the CMSA Core Curriculum for Case Management Third Edition.

Written by renowned author Catherine Mullahy, The Case Manager’s Handbook, Fifth Edition is the ultimate how-to guide for case managers. This practical resource helps case managers build fundamentals, study for the Certified Case Manager (CCM) exam, and most importantly, advance their careers after the exam. Written for all professionals in all practice settings in case management, it uses real-life examples and an easy-to-read, conversational style to examine the case management process while presenting practical procedural information. An excellent daily reference and training guide for new case managers and seasoned professionals in various setting, The Case Manager’s Handbook, Fifth Edition is the “go-to” resource for facing the day-to-day challenges of case management, especially as the nation navigates through the many changes introduced by the landmark Patient Protection and Affordable Care Act. Significantly updated and revised, it contains eight new chapters: * Hospital Case Management: Changing Roles and Transitions of Care * Patient Centered Medical Home, ACOs, Health Exchanges * Evidence-Based Practice * Public Sector Reimbursement * Predictive Modeling * Pain Management * Health Technology, Trends, and Implications for Case Managers * The Affordable Care Act of 2010: Implications for Case Managers Included with each new print book is an Access Code for a Navigate Companion Website for students with objectives, multiple choice questions, and bonus appendices.

Core Skills for Hospital Case Managers: A Training Toolkit for Effective Outcomes Toni Cesta, PhD, RN, FAAN; Beverly Cunningham, MS, RN As of June 20, 2014, contact hours for nurses are no longer available with this product. Finally--an affordable, effective, and consistent training program for your hospital case managers. This one-of-a-kind guide to fundamental case management responsibilities is a necessary reference tool for every hospital case management department. This resource is designed to give case management directors and hospital leaders the tools they need to build and strengthen the basic and advanced skills their case management staff needs to succeed. Core Skills for Hospital Case Managers is an orientation and training manual for nurses transitioning into case management, an easy-to-read reference guide for new case managers, and a source of inspiration, tools, and resources for seasoned professionals. With a flexible format, this book and CD-ROM offer practical information and customizable tools to develop and maintain a wide variety of care management skills. Table of contents Chapter 1: Hospital Case Management 101 Chapter 2: Case Manager Role Chapter 3: Roles, Functions, and Caseloads Chapter 4: The Case Management Process Chapter 5: The Case Manager's Role in Transitional and Discharge Planning Chapter 6: Utilization Management Chapter 7: Managing Long Length of Stay Patients Chapter 8: Denials: Prevention and Appeals Strategies Chapter 9: Reimbursement Chapter 10: The Role of the Case Manager in Patient Flow Chapter 11: Measuring Success: Strategic Outcome Measures Chapter 12: Dealing with the Uninsured and Underinsured Chapter 13: Working with Multidisciplinary Teams Chapter 14: Crucial Communication and Conflict Resolution Learning objectives: Discuss the evolution of hospital case management Explain the different models of hospital case management Determine the various goals of hospital case management Examine the various roles of case management Discuss the variety of functions performed by case managers Discuss the scope of the case manager position Examine staffing ratios in various models List the steps in the case management process Determine the role of case managers in documentation Examine case managers' role in discharge planning List the factors that influence the discharge planning process Determine strategies for improving discharge planning Discuss how hospital reimbursement affects utilization management (UM) List the stages of UM coordination Determine the affect of outside influences on UM Evaluate different payers' regulations regarding UM Examine case management's role in length of stay (LOS) Evaluate strategies for managing patients with long LOS Identify data used to track and trend LOS Evaluate the reasons behind denials Discuss case management's role in preventing denials Examine case management's roles in reversing denials Examine case management's role in reimbursement Determine strategies for effective case management related to reimbursement Evaluate case management's role in patient flow Discuss demand and capacity management Identify strategies for managing patient flow Identify measurable case management outcomes Explain how case managers can track quality outcome metrics Discuss other metrics case management departments can track and trend Examine ways to create a case management report card Discuss the unfunded or underfunded patient populations Describe the role of the ED case manager with unfunded or underfunded patient populations Evaluate strategies for dealing with unfunded or underfunded patient populations Examine strategies for successfully working with multidisciplinary teams Describe sources of conflict with which case managers frequently come in contact Discuss strategies for reducing conflict Intended audience Staff nurses, charge nurses, staff educators, staff development specialists, directors of education, nurse managers, and nurse leaders

"The Case Manager's Handbook, Sixth Edition is an indispensable guide for case managers. Presented in an accessible and conversational style, this practical resource helps case managers learn the fundamentals, study for the Certified Case Manager exam, and advance their careers after the exam. Completely updated and enhanced with information on the latest developments affecting case management, it reflects the rapidly changing healthcare landscape, including the significant effects of the Affordable Care Act."--Back cover.

Prepare for a new career as a case manager—or just upgrade your skills to a whole new level—with the newly updated Case Management: A Practical Guide for Education and Practice, 4th Edition. Ideal for case management certification (CCMC) exam preparation, this is a thorough review of the case manager’s many roles and skills, from acute to post-acute care. Whether you are a nurse transitioning to case management or already active in it, this is your road map to coordinating successful patient care, from hospital to home. Build a strong case management career foundation, with expert, evidence-based direction: NEW chapter on case manager orientation programs that offers orientation checklists, competency assessment, and learning profiles, with available online tools NEW topics on current practice issues and developments, including the impact of the Patient Protection and Affordable Care Act and value-based care NEW content on experiential, problem-based learning—learning practices, training programs, case management team professional development Offers in-depth, evidence-based guidance on: The case manager’s roles, functions, and tasks Key concepts—quality management and outcomes evaluation, legal and ethical considerations, case management process, utilization management, transitions of care The role of the nurse case manager versus social worker role Strategies that ensure effectiveness of case management models Coordinating care, protecting privacy and confidentiality, health insurance benefit analysis, practice standards The Case Management Code of Professional Conduct, accreditation agencies and standards, specialty board certifications Management of resources and reimbursement concepts Case management in various settings—acute care, emergency department, admissions, perioperative services, disease management, insurance case management, palliative care, end-of-life care, hospice, home health care, physician groups, public health/community-based care, rehabilitation Ideal preparation for the CCMC exam—offers a large portion of CCMC exam content—and for Continuing Education Unit (CEU) for Case Management study A must-have desk reference that offers plentiful case studies—considered to be “the bible” of case management

This practical, "hands-on" guide includes vital information every case manager and administrator of a case management program need to be successful. A useful resource for working in the changing face of healthcare, it addresses case managers in all settings with an emphasis on nurse case managers and their role in providing patient care and containing costs. Focusing on the "nuts and bolts" aspects of case management, it discusses the operations of case management programs based on the authors' first hand experiences. Case Management Tip boxes in each chapter highlight important tips and provide easy access to this information. Case studies in several chapters address possible situations the case manager may confront along with the most effective solutions. Key points at the end of each chapter summarize pertinent information. Appendices provide extensive examples of forms and multi-disciplinary action plans used in various healthcare settings.