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:
Social Work Case Manager
A social work case manager’s major responsibility is to analyze their client’s strengths, both individually and in the context of the care system in which they live. A veteran’s hospital, an outpatient mental health clinic, or a hospice care center are all examples of care systems.
Case managers in this sector additionally look at the obstacles that are preventing their clients from reaching his or her full potential.
Nurse Case Manager
In a hospital or institutional context, nurse case managers are in charge of managing and coordinating long-term care for their patients. Their major responsibility is to deliver services that keep their patients in the greatest possible physical condition.
They work proactively rather than reactively in this regard. Nurse case managers may specialize in working with a certain group, such as the elderly, diabetics, or people suffering from a serious medical condition like cancer.
Medical Case Manager
Medical case managers carry out many of the same responsibilities as nurse case managers. Medical case managers, like nurse case managers, work with patients who have long-term medical conditions like HIV/AIDS, heart disease, or diabetes.
Medical case managers will coordinate services for the patient, such as physical or occupational therapy visits, and will monitor their progress to ensure that their treatment plan is being followed.
Mental Health Case Manager
Case managers in the mental health area give hands-on services to improve their clients’ overall functioning. One of the most important responsibilities of mental health case managers is to organize mental health services that are tailored to their client’s individual requirements.
This includes collaborating with clients to set short- and long-term goals, as well as determining the client’s strengths and weaknesses so that a suitable treatment plan may be established.
Clinical Case Manager
Clinical case management entails a variety of tasks such as assessment, planning, resource coordination, and advocacy on behalf of people who are dealing with serious life issues.
Clinical case managers, unlike certain other disciplines under case management, assist people in overcoming a wide range of life concerns, such as poverty, mental health issues, or developmental disabilities.
Substance Abuse Case Manager
Case managers who work only with clients who have a substance addiction problem are primarily concerned with assisting their clients in gaining access to necessary services so that they can remain sober.
The duties of drug abuse case management are similar in all fields of case management. Clients are assessed and relevant interventions that will aid in their rehabilitation are identified.
Legal Case Manager
Case managers who work in the legal profession nearly always do administrative duties. Their principal responsibilities are to ensure that the law office functions smoothly and efficiently, whether it is a private firm or a government institution such as the prosecuting attorney’s office.
Legal case management differs from other types of case management in this sense since there is limited interaction with the client.
Juvenile Case Manager
Children under the age of 18 who have been convicted of a crime are supervised by juvenile case managers. Juvenile case managers frequently provide assistance with navigating the juvenile justice system.
This usually entails meeting with juvenile clients to address the offense with which they have been accused, as well as assessing their social, emotional, and psychological well-being.
Geriatric Case Manager
Case managers who specialize in this field only work with older clients and their families. Individuals engaged in this sector of employment, like those in other case management professions, focus on managing the care of older folks to guarantee the highest possible quality of life.
Acting as a link between the elderly client and medical, mental health, and residential care facility workers is the most important aspect of this position. Geriatric case management is extensively involved in administrative and advocacy activities in this area.
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.