What is Case Management?

What is Case Management?Definition of Case Management*

Case management is a collaborative process, which assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet an individual’s health needs, using communication and available resources to promote quality, cost-effective outcomes.

Philosophy of Case Management*

Case management is not a profession in itself, but an area of practice within a profession. Its underlying premise is that when an individual reaches the optimum level of wellness and functional capability, everyone benefits: the individual being served, their support systems, the health care delivery systems and the various reimbursement sources.

Case management serves as a means for achieving client wellness and autonomy through advocacy, communication, education, and identification of service resources and service facilitation. The case manager helps identify appropriate providers and facilities throughout the continuum of care, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the client and the reimbursement source. Case management services are best offered in a climate that allows direct communication between the case manager, the client, and appropriate service personnel, in order to optimize the outcome for all concerned.

Certifcation :

These are nationally recognized certifications:

CDMS – Certified Disability Management Specialist

CRRN – Certified Registered Rehab Nurse

CCM – Certified Case Manager

CLCP – Certified Life Care Planner

Certification determines that the case manager possesses the education, skills and experience required rendering appropriate services based on sound principles of practice.

What does a case manager do?

A case manager serves as a liaison between the ill or injured person, the doctor and other treating providers, the insurer and employers to identify what services and resources are necessary to promote a return to the highest level of well being. We meet with people in person, or by telephone, and often create letters and reports, to enhance communication between all parties and the insurance company. We help the person who is sick and their family to navigate the healthcare system, providing resources that will be needed to return to a productive life-style.

Why do you need Case Management?

We expect to help you and your family cope with the medical, social, emotional, insurance, and vocational problems related to serious injury or illness. RCM can help with geriatric cases assisting family members with determining placement and care coordination We can support you in making informed decisions and in getting answers to questions about your treatment and your rehabilitation. We assist you in getting the care you need. We do not make decisions for you but rather help give you the tools you need to do so.

Who might refer you to a Case Manager?

Individuals who have specific illness or injury are generally referred for Case Management service by their insurance claims adjuster, physician, employer or family member.

Who Pays for Case Management Services?

The referring source, generally the insurance company, pays for the Case Manager’s service. Sometimes a case manager is hired directly by the provider, patient, family or attorney.