Case or Care Management (4th Edition 2013)
Apollo Managed Care, Inc., January 2013, Pages: 188
Plans, policies, procedures and strategies that ‘work' to improve quality, efficiency of care while controlling unnecessary costs. Specific case management effectiveness data by disease entity and behavioral healthcare conditions for children and adults.
188 pages of policies, procedures and strategies that ‘work' to improve quality, efficiency of care while controlling costs for medical and behavioral healthcare (children and adults). Case management program policies, procedures, job descriptions (nurse and social work CMs). Applicable to ambulatory care, inpatient, homebound and SNF care management. General and specialty case management protocols including mental health care. Resources include authoritative references, example plans, programs, interventions and links
Preface, Disclaimers, Other important information
Introduction to case or care management
Geriatric Case Managers
Patient Selection for CM
Case Management Program
CM – What is it?
CM skills
CM Information Systems
Mentoring
CM – policy and procedures
Hours/days for CM coverage
Social Work Case Management Competency Requirements
Certification requirements for social work case manager
Case Management Accreditation
Hospital UM/Care or Case Management Staff Functions
Roles and responsibilities of hospital-care focused UM staff
Roles and responsibilities of ambulatory-care focused UM staff
Primary case manager
Specialty CM/Clinical Nurse Specialist – roles and responsibilities
Criteria for specialty case management referrals and case acceptance
Specialty case management – policy and procedures
Telephone case management
Criteria for Social Service/Counseling Management -
Specialty case manager – Case closing
Intake Form – example content
Specialty case manager – Discharge form
Hospital case manager – UM variance reports
CM: Skilled Nursing Facility
Skilled vs Custodial (non-skilled) Levels of Care Services
Custodial Level of Care – Questions and Answers (handout)
What are the concerns about SNF admissions?
CM: Home health and hospice services
Post-discharge Case Management
Patient Choice re: HHA Ownership Disclosure Form – Example
Inappropriate Admissions – Change in Status
CM: Discharge planning P&P
Hospitalist program post-discharge transitional management of care
CM: Homebound program
Homebound program assessment survey
High risk screens for new health plan members
CM: New patient preliminary screening triggers and actions
CM: Outcome Measures
CM: Addiction Management
Case Management in the ED for High Utilizers
ED-Observation unit CM
High risk case detection for focused case management
CM Screen example for high risk patients
Case management for disease specific referral programs
Cases (example list) to screen or target for CM services
Congestive heart failure CM
Diabetic Case Management
Nutritional case management
Heparin-coumadin conversion program
HIV – Case Management
Hip Fracture – Case Management
Obstetrical case management
End-of-life care – case management
Palliative care
Mental Health Case Management Services – protocols, policy
- CM triggers for the patient requiring behavioral health care
- CM: Behavioral Healthcare – Policy example
- Clinical case management
- Community-based services
- Depression Care – Case Management
- Children/Adolescent Case Management Services – Oklahoma Foundation for Medical Quality (OFMQ) Case Management Program
- Client Assessment Record (CAR)
Case Loads – 2001 survey data
Position descriptions
Director, Case Management Services
Case Manager, Primary Care/Ambulatory Care
Case Manager, Hospital
Case Manager, Specialty Care
HIV/AIDs Nurse Case Manager
Case Management Coordinator
Social Worker, MSW
Social Worker Case Manager Competency Requirement List
Social Work Director
Discharge Planner: Position description
Post-acute Care Coordinator
CM Candidate Screening Tool
CM: Duties
CM – hours/days for coverage
CM Credentialing Resources
CM Plan – example
Care coordination program – example
CM-related organizations
CM references and resources
Case-mix adjustment; severity of illness resource
Physician advisor role;
Web Sites – Case Management, Nursing
CM Notes
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