Case Management Roles
Case Management is a collaborative process of assessing, planning, facilitating, care coordination, evaluating, and advocating for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost-effective outcomes.
The underlying premise of case management is that when an individual achieves the highest level of wellness and functional capability, everyone benefits:
- The people being served.
- Their support systems.
- Health care delivery systems.
- The various reimbursement sources.
Case management promotes client wellness and autonomy through advocacy, communication, education, service resource identification, and service facilitation. The case manager assists in identifying appropriate providers and facilities throughout the continuum of services while also ensuring that available resources are used in a timely and cost-effective manner to maximize value for both the client and the reimbursement source. Case management services are best provided in an environment that encourages direct communication between the case manager, the client, and appropriate service personnel to maximize the outcome for all parties involved.
A nurse case manager creates, implements, and reviews healthcare plans for geriatric patients, those recovering from serious injuries, or those suffering from chronic illnesses. Case managers work in and out of hospitals and medical facilities. And these registered nurses (RNs) work with doctors and other medical professionals to provide their patients comprehensive care. They are all part of their job of advocating for their patients, coordinating their care, and providing other healthcare services and education.
Unlike specialized healthcare professionals, case management nurses perform various tasks across a wide range of disciplines. Case management nurses are in charge of the following:
Create and manage care plans for patients suffering from severe or chronic conditions such as diabetes, heart disease, Alzheimer’s, and cancer.
Promote personalized treatment options that address a patient’s specific care requirements.
Schedule medical appointments for their patients and follow up to ensure they are attended.
Inform the patient and their family about their health condition.
Provide education and assistance in making complex medical decisions.
Assist patients and insurance providers in promoting quality, cost-effective care with the best patient outcomes.
Specialization in RN Nurse Case Management
Case management nursing is a distinct RN occupation because it offers a more comprehensive approach to health care. As an RN case manager, you can address your patients’ physical and psychosocial needs.
You will also have the opportunity to specialize in an area of interest to you. Some of the most common case management nursing specializations are as follows:
Patient specialization—focuses on a particular patient population, such as the elderly (geriatrics) or children (pediatrics).
Service specialization—concentrates on a particular service area, such as hospice, home healthcare, or rehabilitation.
Duration specialty focuses on the length of patient care, such as short-term injury rehabilitation or long-term illness management.
Disease specialization—concentrates on patients with a specific disease or chronic illness, such as diabetes, cancer, substance abuse, or mental illness.