Who performs the case management function in the organization-based model?
In the organization-based case management model, the case management function may be performed by family members, a supportive care network, volunteers or the client. In the role of a broker, the case manager focuses on _________.
Can the case manager obtain information about the client from other agencies?
If the case manager needs information about the client from other agencies or institutions, the case manager need only to obtain written consent from the agency or institution in order to do so.
What can facilitate the interaction between an applicant and a case manager?
Awareness of congruence between verbal and nonverbal messages can facilitate the interaction between an applicant and a case manager. Effective communication skills include _________. Case manager interviewing skills include all of the following EXCEPT _________.
What is also in case management?
Also refers to the professional background – such as nursing, medicine, social work, or rehabilitation – that case managers bring with them into the practice of case management. A collection of information topics associated with health and human services and related subjects.
What is the primary function of a case manager?
The primary function of case managers is to advocate for clients/support systems. Case managers understand the importance of achieving quality outcomes for their clients and commit to the appropriate use of resources and empowerment of clients in a manner that is supportive and objective.
What is the role of a case manager?
The primary function of case managers is to advocate for clients/support systems.
What are the stakeholders in healthcare?
These stakeholders include the clients themselves, their support systems, and the healthcare delivery systems, including the providers of care, the employers, and the various payor sources.
What is case management knowledge framework?
The case management knowledge framework consists of what case managers need to know (knowledge, skills, and competencies) to effectively care for clients and their support systems. It includes two main elements:
How many phases are there in case management?
The Case Management Process consists of nine phases through which case managers provide care to their clients: Screening, Assessing, Stratifying Risk, Planning, Implementing (Care Coordination), Following-Up, Transitioning (Transitional Care), Communicating Post Transition, and Evaluating . The overall process is iterative, non-linear, and cyclical, its phases being revisited as necessary until the desired outcome is achieved. It also is affected by the care setting where the client and client’s support system are being cared for and the practice setting of the case manager.
What is psychosocial support?
The Psychosocial Concepts and Support Systems domain consists of knowledge associated with the role clients’ cultures, values, beliefs, social networks, and support systems play in clients’ health and well-being, including health behavior and lifestyle. This domain also focuses on the impact of socioeconomic classes on clients’ health conditions, ability for self-care management, health engagement, health literacy and numeracy, and adherence to treatment regimen.#N#Additionally, this domain includes knowledge of the case manager’s role in addressing issues of underinsurance or lack of insurance, charity care, clients’ education regarding health condition and treatment options, counseling and psychosocial support, and clients’ home environments and living arrangements.
What is practice setting?
(Also referred to as practice site, care setting, or work setting.) The organization or agency at which case managers are employed and execute their roles and responsibilities. The practice of case management extends across all settings of the health and human services continuum.
What is adaptive case management?
Sometimes known as adaptive or dynamic case management, case management endeavors to improve the performance of your organization by putting case information front-and-center rather ...
What is the difference between case management and content management?
There are differences between "regular" content management and case management, most notably the inclusion of functions like incident reporting and investigation management. These capabilities involve entire processes unto themselves and can encompass living documents of all kinds that ultimately will need to have content management principles ...
What is a case in a project?
A “case” is any project, transaction, service or response that is “opened” and “closed” over a period of time to achieve resolution of a problem, claim, request, proposal, development, or other complex activity. It is likely to involve multiple persons inside and outside of the organization, with varying relationships to each other, ...
What is process outcome?
The process outcome is the successful resolution of the case. The participants may need to respond against given deadlines, and those involved in managing the case need to see progress reporting and action monitoring against the case.
What is a case in computer science?
A “case” is a compendium of information, processes, advanced analytics, business rules, collaboration, and sometimes social computing that relates to a particular interaction with or issue involving a particular party like a customer, supplier, patient, student, or defendant.
Is a customer interface a CRM?
Customer interfaces may be dealt with in a CRM or help-desk system. Multiple relationships may be required, as any one case, contract or claim may involve more than one customer, knowledge worker, or other contributor. A customer-centric CRM system may be at a disadvantage compared to a document-centric process management system.
What is a gatekeeper in healthcare?
Gatekeeper: Healthcare provider or entity responsible for determining the healthcare services a patient or client may access. The gatekeeper may be a primary care provider, a utilization review or case management agency, or a managed care organization.
What is a coordinated care organization?
Characterized by 1) arrangements with specific providers to deliver a comprehensive set of healthcare services 2) criteria for selecting providers 3) quality assessment and utilization review and 4) incentives for members to use plan providers. AKA Coordinated Care Organization.
What is an MSO?
Specialized entity that provides management services and administrative and information systems to one or more physician group practices or small hospitals. An MSO may be owned by a hospital, physician group, physician-hospital organization, integrated delivery system, or investors.
What is evidence based practice?
Evidence-based clinical practice guidelines: Explicit statement that guides clinical decision making and has been systematically developed for scientific evidence and clinical expertise to answer clinical questions. Systematic use of guidelines is termed evidence-based medicine. EPO:
What is the provision of healthcare insurance policy that requires policyholders to pay for a portion of their healthcare services?
Provision of healthcare insurance policy that requires policyholders to pay for a portion of their healthcare services; a cost control mechanism. Disease management: Program focused on preventing exacerbations of chronic diseases and on promoting healthier lifestyles for patients and clients with chronic diseases.
What is a PPO organization?
PPO: Preferred provider organization. Entity that contracts with employers and insurers to render, through a network of providers, healthcare services to a group of members. Members can choose to use the healthcare services of any physician, hospital, or other healthcare provider.
Definition of Case Management
Case Management Philosophy and Guiding Principles
- Case management is a specialty practice within the health and human services profession. Everyone directly or indirectly involved in healthcare benefits when healthcare professionals and especially case managers appropriately manage, efficiently provide, and effectively execute a client’s care. The underlying guiding principles of case management services and practices of th…
Principal Terms
- Many terms in the CMBOK have multiple meanings, and you may be unclear about which meaning to apply. You might also not interpret the terms in the way the knowledge developers – who are case management experts – thought of them. To get the most out of the knowledge these experts have shared in the CMBOK, take the time to review the following terms. Note that the lite…
The Case Management Process
- The Case Management Process consists of nine phases through which case managers provide care to their clients: Screening, Assessing, Stratifying Risk, Planning, Implementing (Care Coordination), Following-Up, Transitioning (Transitional Care), Communicating Post Transition, and Evaluating . The overall process is iterative, non-linear, and cyclical...
Client Source
- Before looking more closely at the phases of the Case Management Process, first consider what triggers the process. You begin with the identification of a client. Without a client found to be in need of case management services, you have no need to launch the Case Management Process. The client source – that is, how you, as case managers, come in contact with clients and/or thei…
The Screening Phase
- View larger image Click here to view map key for image The Screening phase focuses on the review of key information related to an individual’s health situation in order to identify the need for health and human services (case management services). Your objective of the screening as the case manager is to determine if your client would benefit from such services. Screening promot…
The Assessing Phase
- View larger image Click here to view map key for image The Assessing phase involves the collection of information about a client's situation similar to those reviewed during screening, however to greater depth. The information you collect about your client/support system may include: 1. Past and current health conditions 2. Service utilization 3. Socioeconomic and financi…
The Stratifying Risk Phase
- View larger image Click here to view map key for image The Stratifying Risk phase involves the classification of your client into one of three risk categories – low, moderate, and high – in order to determine the appropriate level of intervention based on your client’s situation and interests. This classification allows you to implement targeted risk category-based interventions and treat…
The Planning Phase
- View larger image Click here to view map key for image The Planning phase establishes specific objectives, care goals (short- and long-term), and actions (treatments and services) necessary to meet a client's needs as identified during the Screening and Assessing phases. You often consider the client’s risk classification or category in the design of the client’s plan of care. Durin…
The Implementing (Care Coordination) Phase
- View larger image Click here to view map key for image The Implementing phase centers on the execution of the specific case management activities and interventions that are necessary for accomplishing the goals set forth in your client’s case management plan of care. This is commonly known as care coordination. During this phase, you as the case manager organize, se…
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