The definition of case management has evolved over a period of time. The most recent definition approved by the Case Management Society of America (CMSA) is as follows:
"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 quality cost-effective outcomes".
The case manager is a recognized expert and serves as an important facilitator among the client, family or caregiver, the health team, the payer, and the community. This can occur in a single health care setting or during the client's transitions through the continuum of care.
In short, case managers are vital participants in the care coordination team who empower people to understand and access quality, efficient health care.
#2 What role does the Case Manager perform?
Depending on the health care organization, the case manager can play distinctly different roles:
- A care provider who helps patients to improve their self-management skills and/or helps caregivers to be more effective in supporting patients
- A collaborative member of the care delivery team who promotes better communication with providers and advocates for implementation of care plans
- A patient advocate who evaluates patient needs and works to surmount problems with access to clinical services*
#3 What job functions do Case Managers perform?
Job functions of case managers revolve around Patient-centered Care, and include:
- Conducting a comprehensive assessment of the client's health and psychosocial needs, including health literacy status and deficits
- Developing a case management plan collaboratively with the client, family/caregiver, health care providers, the payer, and the community to maximize healthcare responses, quality, and cost-effective outcomes
- Coordinating members of the health care team, and the client in the decision-making process in order to minimize fragmentation of services
- Educating the client, the family or caregiver, and members of the health care delivery team about treatment options, community resources, insurance benefits, psychosocial concerns, etc., so that timely and informed decisions can be made
- Assisting the client in the safe transitioning of care to the next most appropriate level
- Striving to promote client self-advocacy and self-determination
- Advocating for both the client and the payer to facilitate positive outcomes for the client, the health care team, and the payer. However, if a conflict arises, the needs of the client must be the priority
#4 What is the job market like for Case Managers?
There is an ever growing need for case managers as evidenced by healthcare institutions employment opportunities across the United States. Research shows where case managers are used; health care quality goes up while the costs go down. A variety of inpatient and outpatient settings are offered, including, but not limited to.
- Hospitals and integrated care delivery systems, including acute care, subacute care, long-term acute care facilities, skilled nursing facilities, and rehabilitation facilities
- Public health insurance programs, Medicare, Medicaid (MediCal), state-funded programs and community-based programs
- Ambulatory care clinics including health care centers and mental health facilities
- Group and private health insurance programs, managed care organizations workers' compensation and occupational health, and long-term care insurance
- Physician and medical group practices, independent and private case management companies, and life care planning programs
- Government-sponsored programs, correctional facilities, military and veteran’s health care
- Provider agencies, home health services, long-term care services, disease management companies, and residential and assisted living facilities
- Hospice, palliative, and respite care programs.
#5 Can I work as a Case Manager immediately?
While most inpatient case managers have a minimum of 2 years experience as a bedside nurse, some graduates are finding they transition to case management within the first year, or even earlier. In the outpatient setting, there are opportunities for immediate employment upon graduation. Of course, opportunities exist for bedside nursing should you wish to explore that option.
#6 What is the future of Case Management?
According to the Bureau of Labor Statistics, case management is one of the fastest growing occupations in our nation, with an estimated growth of 23% between 2012 and 2022**. New team-based models for health care delivery like the patient-centered medical home and advanced primary care have hastened the drive to break down the “silos of care” that for generations defined fragmentation in health care and increased the potential for errors†
Although a number of strategies for health care reform have been espoused and debated, case management has emerged as an important intervention that fosters the careful shepherding of health care dollars while maintaining a primary and consistent focus on quality of care and client self-determination.