686:
stay. Case
Managers concurrently plan for transitions of care, discharge and often post discharge follow up. Case Managers often coordinate with the patient and family, physician(s), funding sources (i.e. insurance, Medicare), and community resources that provide services the patient may need, such as rehabilitation facilities or providers of medical equipment. Through this coordination, hospital case managers' goals are to ensure both optimal patient and hospital outcomes including quality of care, efficient resource utilization, and reimbursement for services. Hospital Case Management is a collaborative practice, consisting primarily of Nurse and Social Work professionals working in collaboration with physicians and other members of the healthcare team.
730:
test the knowledge of Case
Managers working in a hospital/health system. The second component consists of clinical simulations, which test the application of case management knowledge to simulated practice scenarios. Successful completion of the ACM Certification requires passing both parts of the exam, and earns the successful application the ACM credential. This credential must be renewed every four years through demonstrating the required hours of continuing education.
681:...A collaborative practice model including patients, nurses, social workers, physicians, other practitioners, caregivers and the community. The Case Management process encompasses communication and facilitates care along a continuum through effective resource coordination. The goals of Case Management include the achievement of optimal health, access to care and appropriate utilization of resources, balanced with the patient's right to self determination.
615:, which holds that health care does not only involve change in the patient and that high-quality disease care counts the community, the health system, self-management support, delivery system design, decision support, and clinical information systems as important elements in the practice of case management. There is also the
541:. The amount of involvement an insurer can have in managing high cost cases depends on the structure of the benefit plan. In a tightly managed plan case management may be integral to the benefits program. In less tightly managed plan, participation in a case management program is often voluntary for patients.
738:
ACMA is the association solely for
Hospital Case Management professionals, and currently consists of more than 4,500 members, and is represented by 21 state chapters nationwide. ACMA provides hospital-focused education and networking for Case Managers – including nurses, social workers, physicians,
667:
The
American Nurses Credentialing Center (ANCC) is the largest board certification body for nurses in the United States. One of the many certifications that ANCC offers is a Case Management Nurse Certification. Registered nurses who successfully pass ANCC's Case Management Nurse exam are entitled to
729:
The ACM Certification requires professionals to apply, demonstrate two years of hospital case management experience and licensure as a nurse or social worker, and to sit for and pass an examination. The exam consists of two components. The first section contains core case management questions that
444:
of new patients (perhaps from another service if the client has relocated to a new area out of previous jurisdiction, or if client no longer meets the target of previous service, such as requiring a greater level of care). Alternatively, they may be referred after having been placed on an ITO or in
685:
Hospital Case
Managers are professionals in the hospital setting who ensure that patients are admitted and transitioned to the appropriate level of care, have an effective plan of care and are receiving prescribed treatment, and have an advocate for services and plans needed during and after their
610:
There are several models of case management and the distinctions are based on internal and external influences that have bearing on the level of success and differences in outcomes. These, for instance, include local influences such as the response to cost by funders of care and consumer pressure.
725:
To be a hospital Case
Manager requires experience in the hospital setting, typically as a nurse or a social worker. Additional skills specific to case management are learned in the role. Advanced certification is available to Hospital Case Managers through the Accredited Case Manager (ACM)
676:
The
American Case Management Association (ACMA), a non-profit professional membership organization supporting the practice of hospital case management through education, networking, publications, bench-marking and research, defines Hospital/Health System Case Management as:
405:. It involves an integrated system that manages the delivery of comprehensive healthcare services for enrolled patients. Case managers are employed in almost every aspect of health care and these employ different approaches in the control of clinical actions.
726:
Certification, offered by ACMA. The ACM Certification is the only certification that is specifically designed to validate an individual's competency in hospital case management practice, and is offered to both Nurse and Social Work Case
Managers.
247:
466:
A method of managing the provision of health care to members with high-cost medical conditions. The goal is to coordinate the care so as to both improve continuity and quality of care and lower costs.
235:
377:
433:
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.
229:
223:
631:, where ethics a component of the case manager's responsibilities and is concerned with the distribution of finite resources for the benefit of an entire community.
370:
92:
710:
Performance & Outcomes
Management – monitoring, and if needed, intervening to achieve desired goals and outcomes for both the patient and the hospital.
525:, contacting them and actively coordinating their care, plans can reduce expenses and improve the medical care they receive. Examples include identifying
253:
241:
363:
51:
623:, an approach based on difficult problem identification and solutions under uncertain circumstances. Other models also prioritize ethics such as the
1084:
1014:
1079:
146:
417:
dedicated to the support and development of the profession of case management through educational forums, networking opportunities, legislative
215:
86:
159:
716:
Research & Practice
Development – Identifying practice improvements and using evidence based data to influence needed practice changes.
530:
973:
948:
923:
902:
883:
806:
989:
648:
282:
28:
748:
492:
194:
188:
182:
37:
98:
846:
822:
713:
Psychosocial Management – assessing and addressing psychosocial needs including individual, familial, environmental, etc.
1074:
768:
437:
Case management focuses on delivering personalized services to patients to improve their care, and involves four steps:
164:
128:
628:
140:
342:
302:
117:
701:
Clinical Care Coordination/Facilitation – coordinating multiple aspects of care to ensure the patient progresses.
656:
122:
320:
69:
698:
Advocacy & Education – ensuring the patient has an advocate for needed services and any needed education.
758:
612:
773:
538:
414:
134:
77:
1018:
704:
Continuity/Transition Management – transitioning of the patient to the appropriate level of care needed.
616:
325:
57:
897:
Peter R. Koongstvedt, "The Managed Health Care Handbook," Fourth Edition, Aspen Publishers, Inc., 2001
624:
553:
Verify coverage & benefits with the health insurers to ensure the provider is appropriately paid;
522:
202:
470:
Specific types of case management programs include catastrophic or large claim management programs,
644:
526:
441:
17:
619:
such as the rational model, which focuses on economic perspectives and maximum utility; and, the
426:
287:
169:
707:
Utilization/Financial Management – managing resource utilization and reimbursement for services.
969:
944:
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272:
878:
William F. Bluhm, "Group Insurance: Fourth Edition," Actex Publications, Inc., 2003
753:
394:
335:
176:
421:
and establishing the industry's Standards of Practice, defines case management as:
296:
850:
640:
826:
694:
A hospital Case Manager's responsibilities include the following functions:
549:
Case managers working for health care providers typically do the following:
471:
799:
Case Management of Long-term Conditions: Principles and Practice for Nurses
659:, who are not licensed to assess and evaluate the health of their clients.
418:
292:
63:
451:
Evaluation of results for each patient & adjustment of the care plan
81:
514:
Coordinate insured services with any available community services; and
502:
Negotiate rates with providers who are not part of the plan's network;
1015:"Case Management Nurse - American Nurses Credentialing Center - ANCC"
27:
This article is about the US health care system. For other uses, see
462:
In the context of a health insurer or health plan it is defined as:
1054:
276:
248:
Health Information Technology for Economic and Clinical Health Act
556:
Coordinate the services associated with discharge or return home;
668:
use the credential, RN-BC (Registered Nurse - Board Certified).
601:
Assist employees to seek specialized treatment when need arises.
578:
Case managers working for employers typically do the following:
236:
Medicare Prescription Drug, Improvement, and Modernization Act
918:. Sudbury, MA: Jones & Bartlett Publishers. p. 795.
429:, planning, facilitation, care coordination, evaluation, and
968:. Sudbury, MA: Jones & Bartlett Learning. p. 277.
1059:
801:. Malden, MA: John Wiley & Sons Ltd. pp. 19–21.
537:
claims to identify patients who are at risk of end-stage
990:"Certification - American Nurses Credentialing Center"
585:
Follow up after absences from work due to poor health;
569:
Coordinate services with other health care providers.
739:
administrators and other health care professionals.
611:The generic model used in the United States is the
413:The American Case Management Association (ACMA), a
230:
Health Insurance Portability and Accountability Act
943:. New York: Elsevier Health Sciences. p. 48.
627:model developed by Beauchamp and Childress of the
66:/ State Health Insurance Assistance Program (SHIP)
651:. For example, the license would be available to
505:Recommend coverage exceptions where appropriate;
224:Emergency Medical Treatment and Active Labor Act
679:
464:
423:
966:The Leader's Guide to Hospital Case Management
491:Case managers working for health insurers and
893:
891:
582:Verify medical reasons for employee absences;
371:
93:Program of All-Inclusive Care for the Elderly
8:
595:Assist employees with chronic illnesses; and
827:"Standards of Practice for Case Management"
517:Coordinate claims with other benefit plans.
964:Daniels, Stefani; Ramey, Marianne (2004).
647:licensed to practice independently in the
378:
364:
254:Patient Protection and Affordable Care Act
242:Patient Safety and Quality Improvement Act
33:
1055:Commission for Case Manager Certification
1038:Confluence Writing Award--Aaron Sommers'
521:By identifying patients with potentially
52:Federal Employees Health Benefits Program
874:
872:
870:
868:
866:
784:
36:
941:Leadership and Nursing Care Management
663:Nursing Case Management Certification
160:Health insurance in the United States
7:
1060:American Case Management Association
847:American Case Management Association
823:American Case Management Association
792:
790:
788:
734:American Case Management Association
508:Coordinate referrals to specialists;
87:Children's Health Insurance Program
598:Provide on-site wellness programs.
25:
18:Case management (US health system)
639:The Certified Case Manager (CCM)
566:Provide post-care follow-up; and
283:Massachusetts health care reform
29:Case management (disambiguation)
1085:Healthcare in the United States
749:Case management (mental health)
529:in order to ensure appropriate
458:& adjustment of the program
448:Planning & delivery of care
195:Preferred provider organization
189:Health maintenance organization
183:Exclusive provider organization
38:Healthcare in the United States
1080:Insurance in the United States
474:case management programs, and
454:Evaluation of overall program
154:Private Fee-For-Service (PFFS)
99:Veterans Health Administration
74:Prescription Assistance (SPAP)
1:
511:Arrange for special services;
165:Health insurance marketplaces
769:Primary care case management
617:group decision-making models
495:typically do the following:
129:Health reimbursement account
916:The Case Manager's Handbook
914:Mullahy, Catherine (2010).
721:Education and Certification
649:American health care system
629:Kennedy Institute of Ethics
425:a collaborative process of
141:High-deductible health plan
1101:
343:Fair Share Health Care Act
303:Vermont health care reform
118:Consumer-driven healthcare
46:Government health programs
26:
657:Licensed Practical Nurses
499:Check benefits available;
315:Municipal health coverage
123:Flexible spending account
939:Nagelkerk, Jean (2005).
321:Healthcare in California
797:Snoddon, Janet (2010).
759:Medical case management
147:Medical savings account
112:Private health coverage
774:Utilization management
683:
523:catastrophic illnesses
487:Health insurer and HMO
468:
435:
415:non-profit association
351:(Howard Co., Maryland)
135:Health savings account
78:Military Health System
645:health care providers
527:high-risk pregnancies
478:management programs.
397:technique within the
326:Healthy San Francisco
58:Indian Health Service
625:distributive justice
545:Health care provider
399:health care coverage
203:Medical underwriting
1075:Nursing specialties
851:"Scope of Services"
613:chronic care model
445:an inpatient unit.
288:Oregon Health Plan
267:State level reform
216:Health care reform
170:Premium tax credit
653:Registered Nurses
621:garbage can model
561:patient education
533:and watching for
476:transitional care
388:
387:
16:(Redirected from
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1043:
1036:
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1017:. Archived from
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992:. Archived from
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819:
813:
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690:Responsibilities
643:is available to
590:health education
380:
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366:
34:
21:
1100:
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764:Nursing process
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1050:
1049:External links
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1040:Case Managing
1035:
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1021:on 2008-12-01
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1019:the original
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994:the original
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854:. Retrieved
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830:. Retrieved
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754:Managed care
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395:managed care
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336:My Health LA
177:Managed care
297:Connecticut
1069:Categories
1025:2008-11-17
1000:2008-11-17
856:2020-06-18
832:2020-06-18
780:References
641:credential
427:assessment
409:Definition
345:(Maryland)
672:Hospitals
482:Functions
472:maternity
743:See also
655:but not
588:Provide
574:Employer
559:Provide
535:dialysis
442:Referral
431:advocacy
419:advocacy
293:SustiNet
80:(MHS) /
70:Medicare
64:Medicaid
82:Tricare
54:(FEHBP)
972:
947:
922:
901:
882:
805:
606:Models
256:(2010)
250:(2009)
244:(2005)
238:(2003)
232:(1996)
226:(1986)
179:(CCP)
143:(HDHP)
137:(HSA)
95:(PACE)
89:(CHIP)
393:is a
277:Maine
197:(PPO)
191:(HMO)
185:(EPO)
149:(MSA)
131:(HRA)
125:(FSA)
101:(VHA)
60:(IHS)
970:ISBN
945:ISBN
920:ISBN
899:ISBN
880:ISBN
803:ISBN
493:HMOs
218:law
1071::
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978:.
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