Case Management
Source: Catastrophic & Rehabilitation Mgt., Inc.
Case Management is the process of planning, organizing, coordinating, and monitoring the services and resources needed to respond to an individual's healthcare needs...
Case Management is the process of planning, organizing, coordinating, and monitoring the services and resources needed to respond to an individual's healthcare needs for provision of quality and cost effective case resolution. The goal of case management is the provision of quality cost effective healthcare services.
THIS PROCESS INCLUDES:
- Timely identification of individuals, ideally at the onset of an injury or illness.
- Referral to a qualified rehabilitation nurse case manager with a high level of expertise in the area(s) of health care.
- Assessment by the case manager to determine the individual's strengths, challenges, prognosis, functional status, goals, and needs for specific services and resources.
- Development of a plan that identifies short and long term goals, involving the individual, support systems, and interdisciplinary collaboration.
- Identification, procurement, and coordination of services and resources to implement the plan.
- Provision for ongoing evaluation of the individual's progress on the plan as well as of the effectiveness and appropriateness of the services provided throughout the entire spectrum of care.
- Advocacy for the most appropriate cost effective services to assure quality of care and attainment of appropriate goals.
- Promotion of the individual's self advocacy skills to achieve maximum self sufficiency and maximum medical improvement.
ROLE DESCRIPTION OF THE REHABILITATION NURSE CASE MANAGER:
The rehabilitation nurse case manager uses the principles of rehabilitation nursing as defined within the established scope of rehabilitation nursing practice and standards developed by ARN and ANA
The Functions of the Rehabilitation Nurse Case Manager are:
- Obtains necessary authorizations.
- Reviews and analyzes referral information.
- Consults with the individual, health providers, employers, family, legal representatives, and claims/insurance personnel.
- Assesses the individual's personal and medical history, current status, diagnosis, prognosis, current treatment plan, and care provider's level of expertise.
- Assesses the individual's learning needs related to the medical diagnosis, prognosis, treatment providers, treatment options, financial resources, psychosocial adjustment and coping mechanisms, and vocational rehabilitation requirements and potential.
- Assesses the family knowledge base, health status, expectations, and the potential for or actuality of a family member acting as the primary caregiver if necessary.
Catastrophic & Rehabilitation Mgt., Inc., 4163 Clyde Park SW, Suite 201, Grand Rapids, MI 49509. Tel: 800-531-9634; Fax: 616-531-4070.
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