Unit 1: Introduction to Case Management

Discover the true essence of case management as we explore the definition, philosophy, and goals that shape the discipline. Learn the diverse roles, functions, and activities of case managers, and gain a comprehensive understanding of their pivotal contributions to healthcare. 

This unit sets the stage for your transformative journey, equipping you with the foundation to excel in the field.

Unit 2: The Case Management Process

In this unit, you'll dive into the essential aspects of the case management process. 

Learn how to conduct thorough assessments and use the gathered information to identify opportunities for intervention. Develop the skills to create personalized care plans, set achievable goals, and coordinate effective support that results in positive outcomes for your clients.

Unit 3: Ethical, Legal, and Practice Standards

Discover the essential ethical, legal, and practice standards that underpin the field of case management. Gain a comprehensive understanding of CMSA's Standards of Practice, case management ethics, privacy and confidentiality guidelines, legal and regulatory requirements, informed consent, and healthcare and disability-related legislation. 

This unit ensures you are well-versed in the legal and practice standards you must adhere to as a case manager.

Unit 4: Principles of Case Management Practice

Learn the key principles and tools that drive effective case management practice. This unit delves into important topics such as advocacy, client self-advocacy, self-care management, empowerment, engagement, activation, and adherence to care regimens.

Furthermore, you will explore behavioral change theories and stages of change to assess clients and develop customized plans of care plan based on their stage of readiness. 

Mastering these principles is imperative to provide comprehensive and tailored support to your clients that produce results.

Unit 5: Utilization Management and MCG

In this unit, you will dive into the fundamentals of Utilization Management, including a clear understanding of the distinction between Utilization Management and Utilization Review.

Explore the UM Process, Appeals, and Denials to develop a working knowledge of effective Utilization Management practices.

Unit 6: MCG Inpatient & Surgical Care

Through hands-on practice, you will learn how to leverage MCG to assess the appropriateness of procedures and admissions to acute care. Gain proficiency in identifying the optimal recovery course or general treatment course for patients, as well as the criteria for discharge from acute care. Explore the tools available for effective discharge planning, differentiate between observation and inpatient criteria, and determine the appropriate length of stay.

Master the utilization of ISC-Rapid Review Guidelines and develop the skills to utilize them effectively. 

Unit 7: MCG Training-General Recovery Care

Gain practical experience in applying the General Recovery Care guidelines and understanding its core focus. Compare and contrast the nuances between General Recovery Care and Inpatient & Surgical Care guidelines, equipping yourself with the knowledge to determine the appropriate use of each. Explore the utilization of Clinical Indications to assess the suitability of admission to inpatient care and effectively manage the General Recovery Course during an inpatient stay.

Discover the wealth of discharge planning resources embedded within General Recovery Care and gain proficiency in their application. 

Unit 8: MCG Training-Home Care

Learn how to utilize MCG to evaluate the appropriateness of admission to the home care setting. Gain an understanding of the General Treatment Course, its components, and its significance in guiding patient care. Use the Recovery Course to expertly manage a patient's home care status, optimizing their recovery journey.

Lastly, Uncover a wealth of valuable discharge planning resources embedded within Home Care, empowering you to facilitate smooth transitions for patients. 

Unit 9: MCG Recovery Facility Care 

Gain experience in applying the Recovery Facility Care guidelines to determine the appropriateness of admission and optimal patient care in sub-acute, acute inpatient rehabilitation, and skilled nursing facility settings.

Explore levels of care, determine appropriateness using Clinical Indications, manage treatment courses, and access valuable discharge planning resources. 

Unit 10: Care Delivery

In this unit, you will receive comprehensive training on levels of care and care settings, transitions of care, discharge planning, and summary of care records.

This will equip you with the knowledge necessary to ensure timely and appropriate care for your patients as well as ensure adherence to The Joint Commission Standards and CMS Conditions of Participation.

Unit 12: Psychosocial Concepts and Support Systems

In this unit, you will examine many of the psychosocial aspects that influence our client's ability to progress through their plan of care and reach their full wellness potential. 

Explore family dynamics, dual diagnosis, social determinants of health, crisis intervention strategies, support programs, and cultural, spiritual, and religious factors that influence the client's recovery. 

This comprehensive training equips you with a deep understanding of the potential barriers that may hinder desired outcomes, empowering you to develop effective strategies to overcome these obstacles and facilitate positive client progress. 

Unit 13: Communication

In this unit, you will gain essential communication skills employed by case managers. 

Learn the art of client communication, enabling you to establish rapport and effectively gather the necessary information from your client in a timely manner.

Discover effective conflict resolution strategies, and negotiation techniques, empowering you to navigate challenging situations with confidence and professionalism. 

Additionally, learn the art of documentation and reporting, enabling you to maintain accurate records of all communications and interventions, resulting in streamlined case management and optimal client care.

Unit 14: Quality

Gain the tools and knowledge to effectively assess and measure the impact of your case management efforts, by delving into essential topics such as cost-benefit analysis and program evaluations. This provides you with valuable insights into the value you bring to your organization by effectively demonstrating the positive impact of your case management efforts. 

Additionally, familiarize yourself with the standards and requirements of esteemed accreditation bodies like URAC and JCAHO. This equips you to deliver case management services that consistently meet and exceed accreditation standards, elevating the quality of care and outcomes for your clients.

Unit 15: Reimbursement Methods and Managed Care Principles

Case managers must be proficient in the reimbursement aspects of patient care. 

Recognizing that nurses in most settings are not typically involved in reimbursement aspects, we provide extensive training to bridge this gap and equip you with the necessary knowledge to excel in your new role. 

We start off by exploring the key principles, terminology, and concepts related to insurance, equipping you with the knowledge to navigate the complex landscape of healthcare financing. 

Next, you will develop a foundational understanding of Medicaid, the Affordable Care Act (ACA), Coordination of Benefits, and COBRA, ensuring you are well-versed in the essential components of these programs.

Additionally, we dive into the fundamentals of Medicare, exploring its basics, reimbursement protocols, the Medicare Two-Midnight Rule, and Value-Based Programs ensuring you have a comprehensive understanding of these critical components.

And finally, you will discover alternative financial resources that empower you to identify appropriate non-traditional avenues and demonstrate creativity in managing each case.

With this unit, you'll gain the expertise to navigate the complex world of reimbursement and effectively manage the financial aspects of case management, enhancing the overall quality and efficiency of your practice.