Case Management

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   There are a variety of accepted definitions given by The American Nurses Association, 1988 - The Center for Case Management, Zander, 1995 - and The Commission for Case Management Certification, 1996. These organizations have a common theme of defining case management as a collaborative process which strives to provide for an individual's health needs across the continuum in a manner which optimizes outcomes, uses patient care resources efficiently and reduces costs where appropriate.

The underlying principles and goals of case management are consistent. As a system for providing patient care, case management is designed to ensure that quality care is provided in the most cost-effective manner possible. Identifying the need, potential problems and interventions, plus documenting treatment, education and outcomes improves patient satisfaction leading to a more independent, quality life for the patient as well as family members.

Why is Case Management necessary?

Case management is the dynamic intervention provided by a health care professional that acts as a liaison between members of the health care team, the insurance carrier and the patient. Each case is different with parameters being set by the individual's medical history, specific injury or chronic disease, and support system. Needs are identified by close involvement with the patient, family and health care team to assure communication is established and implemented, with an emphasis on outcomes. The outcome-based approach results in quality-based medical services up front. The result is identification of needs through assessment, establishment of a goal-oriented treatment plan, implementation of that treatment plan, and documentation of results of medical intervention through the recovery phase. Specific goals are risk identification, accident prevention, identification and prevention of possible medical complications, promoting independence and community integration ... all, thereby, contributing to improvement of the quality of an individual's life. The Case Manager is the facilitator involved in all phases of acute care, rehabilitation treatment and also oversees the medical management, intervening if medically necessary. This role includes teaching the patient to participate in their treatment plan. The trust built within this system increases the likelihood of quality, timely medical treatment with the appropriate referrals to specialists to maximize the outcome goals whether they are community integration or a return to work in some capacity.

Who needs a Case Manager?

Case Managers can be employed by the insurance company, internally by the hospital or rehabilitation center, or as independent intermediaries, such as Life Care Planning Consultants, Inc. A trained and qualified Case Manager can make all the difference for the patient by showing the long-term financial effects of a decision. Immediate costs for appropriate and quality care are reflected in future cost savings for prevention of complications and further disability.

What makes a qualified Case Manager?

To date, approximately 303 Case Managers have completed the certification process as standardized by the Commission of Case Management Certification (CCMC) of Rohlwing Meadows, Illinois.

Ms. McDaniel received certification as a Case Manager in 1993, and has proctored the Case Management Certification Examination in St. Louis, Missouri. In June 1999, she attended a workshop at CCMC Headquarters to prepare examination questions, and is an active member of the Case Management Society of America.