What Can a Case Manager Do?

Depending upon who a case manager is employed by, whether it is an independent company, the entity providing medical care or the organization underwriting the insurance for an employer, there may be benefits and services which are provided that aren’t known about or considered by those enlisting a case manager’s aid.  Let’s take a look at just a few:

• Coordination and facilitation of patient care and the prescribed treatment plan

This may seem obvious, but it goes beyond the obvious when you consider that, because of their experience, case managers can make a huge difference in making sure the patient’s treatment plan is carried out in an effective and organized way.

• Continuity/Transition of Care

Case managers will oversee the transition of care to be sure important care issues don’t fall between the cracks, compromising the patient’s health and recovery outcome.  The case manager can be a liaison between not only physicians or specialists when care is transitioned from one to another, but also transitions between facilities or a care facility and home.

• Performance and Outcomes Management

Because a case manager takes charge of the previous two items, the patient’s progress is monitored closely to be sure steps within the treatment plan are implemented as needed.  It’s the case manager’s job to know if a patient needs to be guided back on track to insure the outcome of his or her treatment is as successful as possible.

• Integrated Health Management/Holistic Considerations

A case manager, when able to work closely with the patient, becomes very familiar with not only the physical aspects of the patient’s health, but also the mental and behavioral aspects, which will have an impact on the physical health of that patient.  Through the insights provided by a case manager in the area of integrated health, a patient’s treatment outcomes can be positively impacted and improved.

• Advocacy and Education

Part of a case manager’s responsibility is to assist the patient in becoming an advocate for his or her medical treatment and care.  It is extremely important to educate patients about the services that are at their disposal and how to gain access to them once they are on their own outside a medical facility.  It is also imperative to educate them on their illness or disease and how they can improve their future health outcomes by exercising preventive measures and following the treatment protocol set up for them.  They need to have the knowledge that will help them to be proactive and keep them out of the hospital and, hopefully, even the doctor’s office, down the road.

• Utilization/Financial Management

The financial aspects of patient care are also a major focus for all involved.  Case managers can oversee that the most effective resources are utilized for a patient’s care, that there aren’t duplications occurring or inefficiencies taking place that can mean unnecessary dollars being spent.  Case managers are also able to negotiate with out-of-network providers and/or, if necessary, work with secondary coverage plans to be sure all options are taken advantage of.

When working with an independent case management company, such as Primary Pediatric Management, you may also have extra services provided, such as:

• Onsite and telephone case management
• Workmen’s Compensation case management
• Legal Nurse Consulting
• Life Care Planning
• Wellness Programs
• Utilization Reviews

The broad spectrum of care management that can be provided when enlisting the services of Case Managers is highly valuable to everyone involved…from the patient to the physicians and medical staff to the insurers.  If you have questions about case management and how it can best serve your needs, please feel free to comment on this post.