Nursing case management

Definition of Case Management

The Case Management Society of America's (CMSA) definition of case management as published on their website is:

"Case management is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes."

You will:

• evaluate admissions for medical necessity
• provide clinical information to payor sources to obtain authorization for the hospital stay
• work closely with the medical team in following the plan of care
• assist with creating a safe and cost effective discharge plan
• assess the patients benefits for proper utilization of services
• set up home health services and equipment

You may:

• perform onsite clinical reviews at your assigned facilities
• perform telephonic clinical reviews for your assigned facilities
• assist the hospital CM with discharge planning

You may:

• perform the admission assessment to home health
• obtain insurance authorizations
• obtain physician orders
• coordinate the patient's plan of care
• assist with acquiring additional services as needed
• perform supervisory visits as mandated
• perform additional visits and call patients as needed