Foundations of Case Management

This course provides nurses with a general working knowledge of case management practices and the case management process preparing them to provide effective case management services in an appropriate, cost-effective manner which are consistent with CMSA Standards of Practice.

This training will give case managers the firm foundation to build on with institutional policies and procedures. Participants will also receive training on tools used by case managers including MCG and assessment tools.

Training includes:

·       The definition, philosophy, and goals of case management as well as the case managers roles, functions, and activities. This provides the case manager with a thorough understanding of the practice of case management and the role of the case manager.

·       Comprehensive training on the case management assessment and how to use the information obtained during the assessment to identify opportunities for case management intervention.

·       How to create, implement, and coordinate a case management plan of care including the development of short- and long-term SMART goals. This allows the new case manager to immediately begin positively impacting clients resulting in better outcomes.

·       Tools such as depression screenings, health literacy assessments, and the Patient Activation Measures and how they are used by the case manager to assess their clients and create a plan of care to address any issues identified.

·       Ethical, legal, and practice standards including CMSA’s Standards of Practice, case management ethics, privacy and confidentiality, legal and regulatory requirements, informed consent, and healthcare and disability-related legislation. This ensures the new case manager has a thorough understanding of the legal and practice standards applicable to case management.

·       Principles of case management practice including advocacy, client self-advocacy, client self-care management, client adherence, client empowerment, client engagement, client activation, and adherence to care regimen. In addition, there will be basic training on behavioral change theories and stages allowing the case manager to assess the client and develop a plan of care based on the client’s stage of readiness. This ensures the case manager understands her role of empowering the client to make lasting changes and take charge of their health and wellbeing, in addition to giving the case manager the training and tools to do so.

·       Utilization management concepts including extensive MCG training and practice. This included case studies to review pre-service notification requests for medical necessity services as well as to review clinical information for concurrent reviews, extending the length of stay for inpatients as appropriate, or referrals to other network providers.

·       Training on levels of care and care settings to promote appropriate levels of care is received by the patients in a timely manner

·       Transitions of care, discharge planning, and the summary of care record including TJC Standards related to these as well as CMS CoP related to discharge planning.

·       Psychosocial concepts and support systems including cultural, spiritual and religious factors, family dynamics, dual diagnoses, social determinants of health, crisis intervention strategies, and support programs. This training allows the case manager to understand barriers to reaching desired outcomes and develop strategies to overcome these barriers.

·       Reimbursement methods and managed care principles including insurance principles, terminology, and concepts as well as a basic understanding of Medicaid, the ACA, Coordination of Benefits, and COBRA. Nurses in most settings are not involved in the reimbursement aspects of treating the patient. For this reason, a large amount of training is provided to ensure the case manager has the knowledge needed to perform in her new role.

·       Medicare basics, reimbursement under Medicare, the Medicare Two-Midnight Rule, and Value-Based Programs.

·       Alternative financial resources equipping the case manager to identify appropriate alternative and non-traditional resources and demonstrate creativity in managing each case.

·       Communication skills including conflict resolution strategies and negotiation techniques.

·       Documentation and reporting, preparing the case manager to maintain accurate records of all communications and interventions and provide timely verbal and written reports.

·       Quality and outcomes evaluations and measurements including cost-benefit analysis and program evaluations equipping the case manager to demonstrate the value case management brings to an organization.

·       The standards and requirements of accreditation bodies such as URAC and JCAHO. This equips the case manager to provide case management services that are consistent with accreditation standards.

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