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Case Management BasicsPublic Health Nursing Population Centered Health Care in the Community

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What are the components of the "planning" competency of case managers?
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Goal setting, need identification, service planning and resource allocation
What are the components of the "Service coordination and referral" competency of case management?
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Service delivery, referral services, and service coordination
What are the components of the "Monitoring" competency of case management?
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Client status, service delivery, crisis management and need for reassessment or change in services
When a case manager acts as an agent for provider services that are needed by clients to stay within a coverage plan according to budget and cost limits of a health plan, they are acting in the role of ________.
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Broker
When a case manager works with providers, suppliers, the community and other case managers to provide case management expertise in programmatic and individual applications, they are acting in the __________ role.
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Consultant
When a case manager arranges, regulates, and coordinates needed health services for clients at all necessary points of service, they are acting in the _________ role.
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Coordinator
What activities are performed by a case manager when performing in the educator role?
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-Educating clients, family and providers about the case management process, delivery system, community health resources and benefits coverage so a decision can be made by all parties
When a case manager supports all parties in working towards a mutual goal, they are acting in the _______ role.
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Facilitator
When a case manager provides a formal communication link between all parties concerning the plan of care management, they are serving in the ________ role.
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Liaison
When a case manager counsels and guides the development of the practice of new case managers, they are acting in the _______ role.
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Mentor
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When a case manager provides information to parties on status of member and situations affecting client safety, care quality, and client outcome, and on factors that alter cost and liability, they are acting in the _________ role.
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Monitor/Reporter
What are activities performed by a case manager when they are acting in the negotiator role?
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They negotiate the plan of care, services and payment arrangements with providers; uses effective collaboration and team strategies.
When a case manager provides information, supports benefits changes that assist the member, family, PCP and capitated systems, they are serving in the role of _________.
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Client advocate
When a case manager formulates and monitors specific, time-sequenced critical path and care map plans and disease management protocols that guide the type and timing of care to comply with predicted treatment outcomes for the specific client and conditions; attempts to reduce variation in resource use, targets deviations from standards so adjustments can occur in a timely manner, they are acting in the role of ____________.
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Standardization monitor
What does a case manager do when acting in the role of Systems Allocator?
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Distributes limited health care resources according to a plan or rationale.
What are the knowledge domains for case management? (Essentially, what do they need to know?)
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-Health care finances and finances of the client populations -clinical knowledge -knowledge of resources within an institution/community and ability to facilitate development of needed resources -transition planning -management skills -teaching/counseling/education skills -program evaluation/research -performance improvement techniques -Eligibility requirements of third party payers -Peer consultation/evaluation -legal issues -clinical and management information systems -technical in
What are the five rights of case management?
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Right Care Right Time Right provider Right setting Right price
What three tools are useful to case management practice?
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Case Management plans, disease management and life care planning tools
What is a criticism of Case management plans/critical pathways?
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They are rarely evidenced based, they are based more on "expert knowledge" within an institution and are therefore difficult to test using scientific methods
What are considered key incidents of a crtical pathway/case management plan?
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Consults, tests, activities, treatments, medications, diet, discharge planning and teaching
What is the impetus for a revision of a critical pathway/care plan management?
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A body of evidence that supports an adjustment
  
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