Published Mar 13, 2014
You are reading page 2 of Case Management in nursing
nurseprnRN, BSN, RN
Skeptical is not categorically a bad quality. :) Asking whether we are being asked to do someone's homework is not unreasonable, as you will quickly discover if you spend any time at all on the Student fora. :)
When students ask us questions like these, we ask them to tell us what they know already and where their confusion lies, but we tell them we don't think asking for the answers on an anonymous internet forum is probably something their faculties will look kindly upon. If these questioners then say they're, oh, working nurses who need ideas on how to get more info, we generally fall all over ourselves helping them find resources. But it's almost always a homework question, and someone heard that AN was the place to get your homework done. Alas ...
Case Management really varies place to place. The case management I am currently doing is really disease management. I work with patients on better health outcomes and lower medical costs.
I am an acute care case manager, which means I am an RN case manager in a hospital. My role is to make sure we get paid. I review charts to ensure patient's meet inpatient criteria, to identify and prevent delays in treatment, and request discharge orders from physicians when patients no longer need to be inpatient. I work with a social worker and together we arrange for patients to transfer to lower levels of care (SNF, LTAC, ALF) and home with home health care or necessary DME. We ensure patients are discharged to the appropriate level of care and with necessary services to prevent readmission, which lowers our reimbursement.
Everything handled in the case management department comes back to getting the money. We are there to maximize our payment/reimbursement and to ensure the hospital adheres to medicare/medicaid (CMS) guidelines and follows our contracts with managed care companies.
Case Managers in Hospice and Home Care manage the ongoing treatment plan of care for their patients while also delivering nursing care to their patients.
Case Managers in Primary Care settings often manage disease states and follow groups of patients who suffer from those diseases. Their goal is to improve patient comprehension, compliance, and outcomes in general.
Case Managers in the acute care setting, as mentioned earlier, seek to insure that coordinated care occurs which meets the standards for care, meets standards for reimbursement, and assists the involved disciplines in creating the post hospitalization plan for the patient.
Case Managers in the insurance world advocate for the patient to acquire appropriate care in the most efficient and cost effective fashion with the goals of restoring health and function as quickly as possible.
By using the site, you agree with our Policies. X