The Who, What, When, Where, Why & How of Case Management

With the increasing concern throughout the country over cost-effective health care, qualified case managers are very much in demand in health care services. This is true in areas ranging from nursing to social services. Accordingly, here is an introduction to the Who, What, Where of case management and the How of becoming a certified case manager in health services.

Who. The term “case manager” applies to anyone whose role in health care services includes coordinating the program of care from inception to termination of care. This includes not only experienced nurses, but also social workers, geriatric counselors, occupational and respiratory therapists, etc., with a more programmatic approach to case management theory and skills.

What. Case managers function much like project managers in non-health industries, with responsibility for coordinating the delivery of health care services. Given the intricacies of health care systems, effective management requires an understanding of systems, reimbursements, legal issues, and professional practice issues. Anyone who has dealt with Medicare, Medicaid, managed care, and commercial carries can appreciate the importance of expertise in these areas.

Where. Case managers work in a variety of settings, including hospitals, clinics, out-patient settings, and even homes. Case management involves identifying specific health care needs, designing a treatment plan, and implementing it to produce cost-effective outcomes for health care.

How. Additionally, given the ethical issues and dilemmas that can occur in providing services that involve serving human needs, case management involves an understanding of legal issues and risk management. Special attention is usually given to the processes of team work groups, discharge planning, disease management, and outcomes management. Case managers must be involved in the quality improvement process, both definition and measurement. Advanced training may involve learning about complimentary health care and its modalities.

Why. The “Why” in case management should be clear by now. Through deliberate planning and integration of services, the needs of health care consumers and provider systems can be better optimized.

How does one become a case manager? While some health care professionals may have learned to do this on the job, there are now several training options. Educational programs in case management have been designed to offer certifications and even master’s degrees. For busy professionals, online courses provide greater accessibility to the material that will allow them to add evidence-based structures and objective outcome goals to the planning and implementation of health care services.

Those wishing to pursue a credentialing or degree program in health care case management will find many continuing education events, seminars, courses, independent study programs, and other opportunities, both face-to face and through distance learning. Checking into the stability and reputation of the educational providers can help ensure that it is a quality program that will open further career opportunities.