What Kind of Work Does a Case Manager Do?
Although case managers work in a lot of environments, some common elements include:
Assessment, which is the process of identification of the condition/needs, abilities and preferences of the individual, which leads to the development of a plan of care.
Care planning, which is a kind of health care map, including goals and preferences. The care plan defines strategies and next steps towards achieving the desired outcomes. The ultimate goal is to help individuals take control of their care and be actively involved in evaluating the experience.
Alignment, which means case managers work to align all the moving parts and puts the plan into action with the individual.
Evaluation/Outcomes Measurement, which tells the individual and case manager what’s working, what’s not working and what needs to be modified (plan, goals, etc.). Finally, it identifies what progress is being/has been made toward individual goals.
Promotes Client Self-Determination, which means the individual learns the skills necessary to take control of their care with confidence. In other words, they know what’s wrong with them, what they need to do about it, and the value of doing so.
What is not Case Management?
The following list of activities are not considered core functions to the case management process. While these roles may be important components of the health care process, individuals who spend the majority of their time performing these activities or in whom case management activities are considered secondary, e.g., first a clinic nurse and secondarily a case manager, are not considered to be practicing case management.
• Benefit determination
• Utilization management
• Administrative tasks
• Direct patient care not related to case management assessment and intervention
• Quality management
• Risk management
• Claims adjustment
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