Case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources. The goal is simple and clearly defined: promoting patient safety, quality of care, and cost-effective outcomes.
A Case Manager, according to the Case Management Society of America (CMSA), is a ‘generic term’ to represent an employee whose major purpose and function is to facilitate the case management process. Individuals working in case of management jobs in academics, healthcare, education, research, insurance, welfare, social and human service settings, and private practice are examples of this.
The phrase ‘Case Manager’ dates back to the 1980s when the term replaced previously used ‘Caseworker’ as people took on more responsibility for managing resources, finding support, and organizing services.
The CMSA now defines ‘case management and the job of the ‘Case Manager’ as follows:
Case management is a method that entails a series of collaborative phases that help clients gain access to the resources they need to achieve their goals. Client identification (screening), assessment, risk stratification, planning, implementation (care coordination), monitoring, transitioning, and evaluation are all important phases in the case management process.
Within the case management process, the Case Manager carefully considers the client’s individual, diverse, and special needs, including aspirations, choices, expectations, motivations, preferences, and values, as well as available resources, services, and supports, at each phase of the case management process.
The core principle of case management is that when a person achieves their optimal level of wellness and functional capability, everyone benefits: the people being treated, their support systems, healthcare delivery systems, and various reimbursement sources.
Through advocacy, communication, education, the identification of service options, and service facilitation, case management helps clients achieve wellness and autonomy.
Throughout the continuum of services, the case manager assists in identifying appropriate providers and facilities, as well as 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 competent service personnel in order to get the best possible outcome for all parties involved.
A professional case management certification verifies that a case manager has the necessary education, abilities, and experience to provide suitable services based on sound practice standards.
The person-centered approach of social workers is very similar to case management practice. In reality, since the profession’s inception, case management has been a major role in social work.
Social workers are valued members of interdisciplinary and, increasingly, transdisciplinary teams because of their whole-person perspective and skill set. It may be impossible for these teams to take a truly holistic strategy without the assistance of a social worker.
A professional and collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual’s health requirements is characterized as case management, according to the Commission for Case Manager Certification, 2015.
The highest level of obligation for the case manager is to the patient (client). Case managers have a responsibility to coordinate care that is safe, timely, effective, efficient, equitable, and client-centered on behalf of these persons.
The nine iterative steps that make up the case management process are as follows:
Case managers take into account the individual’s cultural beliefs, interests, wishes, requirements, and values throughout the case management process.
Case managers are in charge of assisting clients and their support systems in evaluating and understanding care alternatives, determining what is best for their requirements, and taking action to accomplish their goals and objectives.
According to Case Management Body of Knowledge, the case management process also helps healthcare organizations and professionals achieve their objectives, such as providing safe, quality, cost-effective, and efficient treatment, as well as showing compliance with regulatory and accrediting criteria.
The nature of a case manager’s job’s responsibilities is largely determined by the location and type of employment. The day-to-day responsibilities of a nursing case manager, for example, are very different from those of a penitentiary case manager.
Case managers collaborate with clients, as well as a number of other professionals and organizations, to ensure that they have the resources they require to achieve their objectives. The client’s objectives are determined by the circumstances. A client of a correctional case manager, for example, might want to learn a job-related skill during his or her time in prison.
A client of a juvenile case manager could want to get all A’s and B’s on his or her report card next term. Goals might range from short to long-term, and from significant to little, but case managers are there to help you every step of the way.
Case managers work in a wide range of situations, including but not limited to:
Nurses are generally in charge of case management, however, this is not always the case. A different type of specialist may give case management services depending on the situation.
Someone who provides case management services in a substance addiction rehab facility, for example, could have a background in substance abuse counseling. Medical social workers are frequently involved in case management.
Before receiving official accreditation, hospital case managers must have a license or certificate in a health or human services discipline (such as nursing or social work) and 12 to 24 months of field experience.
If you want to work as a case manager, you must first learn about the education, licensure, and certification requirements in your state as well as the organization where you want to work (i.e. an insurance company, a hospital, a home healthcare company, etc.).
In most situations, you’ll need a background in a profession like nursing or social work, but the requirements will vary based on the job you’re applying for.
State medical boards and regulatory departments regulate those underlying professions, which have their own licensing standards. Due to the fact that medical licensing is done on a state-by-state basis, this might become problematic if the case manager’s employer has customers in numerous jurisdictions.
Most states and employers will require case management certification in addition to the underlying education and professional licensure. For example, the Commission for Case Manager Certification or the American Case Management Association may require you to obtain a CCM (Certified Case Manager) or an ACM (Accredited Case Manager) certification.
If you’re a social worker, the National Association of Social Workers offers certification as a Certified Social Work Case Manager (C-SWCM) or a Certified Advanced Social Work Case Manager (C-ASWCM). (It’s worth noting that the Commission for Case Manager Certification and the National Association of Social Workers have collaborated to allow social workers to take the CCMC certification exam for free.)
You’ll want to be sure you understand the education, experience, licensure, and certification requirements for the position you’re applying for, as they will vary by state and job.
The average nurse case manager in the United States earns $72,655 per year, according to PayScale. However, the average pay for non-nursing case managers is lower, with the overall average compensation for a medical case manager estimated to be around $50,550 by late 2020.