Interdisciplinary Health Care Team
Team Members - Care/Case Manager
Who is a Care/Case Manager?
The terms Care Manager and Case Manager are used interchangeably depending upon the particular setting and/or facility. Care/Case Managers work in a variety of health care settings, including acute inpatient hospitals, managed care organizations, home care agencies, community agencies, workers’ compensation, disability, skilled nursing facilities, and occupational health. This summary addresses the hospital-based Care/Case Manager in the acute care setting.
The hospital Care/Case Manager works closely with the patient and his or her family, along with the physician and the interdisciplinary health care team, to move the patient from one phase of care to the next. This facilitating/coordinating role may include discharge, transitional planning, or utilization management.
The definition of case management as outlined in the Case Management Standards of Practice and approved by the Case Management Society of America is “a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes.”
What does a Care/Case Manager do?
Hospital care/case management models can vary from facility to facility. One of the more common models used in acute care facilities is the integrated care/case management model of utilization management, discharge planning, outcomes management, and variance analysis.
The hospital Care/Case Manager assesses the patient’s needs, typically for a home discharge or to another health care facility, develops a plan of care based on his or her assessment, facilitates the plan of care, and advocates for the patient.
What education, training, and experience must one have to function as a hospital Care/Case Manager?
The hospital Care/Case Manager is typically a licensed registered nurse with previous hospital and/or home care experience. Medical social workers can also be found in acute care settings. This type of care management may focus on the long-term care of patient populations at risk for re-hospitalizations or long-term care placement.
How and by whom is a Care/Case Manager supervised?
Hospital Care/Case Managers are supervised by the director or manager of Care/Case Management.
What are the typical day-to-day activities of a Care/Case Manager?
A typical day for a hospital Care/Case Manager may include:
- reviewing the charts of a caseload of patients (approximately 20 to 30)
- reviewing for appropriate length of stay and appropriate care and services (utilization review)
- if delays are identified, proactively working to coordinate tests, therapy, etc.
- making rounds with the physician, residents, or other members of the health care team
- communicating with the interdisciplinary health care team and patient to facilitate transitional planning
- communicating with the patient and/or family for home care or transitional planning
- performing outcomes monitoring and variance analysis
- communicating with the payors, for example, calling managed care organizations for authorizations
Must a Care/Case Manager be licensed or certified to function in his or her role as part of the health care team?
The hospital Care/Case Manager is typically a licensed registered nurse. Some hospital facilities may also employ licensed social workers as Care/Case Managers. Certification in case management is preferred. Certifications in case management include, but are not limited to:
- CCM (Certified Case Manager) by the Commission for Case Manager Certification
- Cm (Nurse Case Manager) by the American Nurses Credentialing Center
What types of patients would benefit from the care of a Care/Case Manager?
Patients who would benefit from the care of a Care/Case Manager include:
- geriatric patients
- patients with chronic care needs
- patients requiring transitional planning to home care, nursing homes, assisted living facilities, etc.
How and when does a Care/Case Manager become involved in the care of a particular patient?
Depending upon the particular hospital’s policies, a Care/Case Manager can get involved with the patient at admission or when the patient is stable enough for discharge or transitional planning.
