Foundations of Case Management and Utilization Management/MCG Course Outcomes for Each Area

Foundations of Case Management

Introduction to Case Management Part 1-The Case Management Process, Philosophy, and Principles of Practice

The learners will be

  • Better able to explain what case management is, as well as the philosophy and goals of case management practice.
  • Better able to explain how the functions and activities of the case manager will vary based on the work setting.
  • Better able to compare the different case management models used in the inpatient setting.
  • Better able to identify the skills and qualities I have, as well as those that need to be developed to be a competent case manager.
  • Better able to list the components of the Case Management Process.
  • Better able to describe the importance of the initial case management assessment.
  • Better able to explain the importance of client involvement in creating the case management plan of care.
  • Better able to explain the possible legal ramifications of terminating case management service.
  • Better able to identify ways that case managers advocate for their clients and client’s family and/or family caregiver.
  • Better able to identify ways case managers can increase client activation and engagement.
  • Better able to describe how case managers use evidence-based practice guidelines, standards of care, and clinical pathways.

Introduction to Case Management Part 2 – Ethical, Legal, and Practice Standards for Case Managers

The learner will be:

  • Better able to identify the practice standards to which a case manager is held.
  • Better able to explain the difference between an ethical situation and an ethical dilemma.
  • Better able to explain privacy and confidentiality related to case management.
  • Better able to apply healthcare and disability-related legislation to case management

Introduction to Case Management Part 3- The Delivery of Case Management and Utilization Management Services

The learner will be:

  • Better able to compare utilization review and utilization management.
  • Better able to explain the utilization management process.
  • Better able to list factors used to determine acuity and severity levels.
  • Better able to describe how to perform medication reconciliation per Joint Commission guidelines.
  • Better able to compare the different care settings available to the client and the level of care provided in each setting.
  • Better able to identify the tools used to assess for hospice appropriateness.
  • Better able to list the health coaching process.
  • Better able to select the rehabilitation delivery system to best meet a client’s needs.
  • Better able to identify the assessment of physical functioning used in rehabilitation.
  • Better able to identify the different tools and resources used to assist the disabled person or injured worker to obtain or maintain employment.
  • Better able to identify barriers to effective communication.
  • Better able to utilize the appropriate type of question for the situation and desired response.
  • Better able to list the various ways case managers communicate with others and best practice for each.
  • Better able to list the 5 conflict resolution strategies.

Introduction to Case Management Part 4-Psychosocial Concepts and Support Systems for Effective Case Management Practice

The learner will be:

  • Better able to identify the impact social determinants of health have on individuals.
  • Better able to explain the importance of including a cultural and spiritual assessment as part of the initial case management assessment.
  • Better able to distinguish between an adaptive family and a maladaptive family.
  • Better able to describe interventions the case manager can take if he/she identifies that the patient’s caregiver is at an increased risk for abusing the client, that may reduce the threat of abuse.

Introduction to Case Management Part 5 – Healthcare Quality and Reimbursement Principles for Case Managers

The learner will be:

  • Better able to describe the role case managers and other members of the healthcare team play in ensuring safe quality healthcare.
  • Better able to describe how case managers can positively impact Medicare’s Value-Based Programs (VBP).
  • Better able to list 2 accreditation bodies that accredit case management programs.
  • Better able to describe the importance of Quality Improvement in case management programs.
  • Better able to discuss the various reimbursement and payment methodologies that are used today.
  • Better able to identify patients that may be eligible for Medicaid and the types of services for which they may be eligible.
  • Better able to identify the 4 parts of Medicare and what each cover.
  • Better able to identify non-traditional resources that are available to clients.

Utilization Management and MCG Course

The learner will be:

  • Better able to utilize MCG software to identify the patient’s stage of the optimal recovery course or general treatment course.
  • Better able to utilize MCG software to apply available tools to the discharge planning process.
  • Better able to utilize MCG software to compute if a patient meets observation vs inpatient criteria.
  • Better able to utilize MCG software to apply the General Recovery Care guidelines.
  • Better able to utilize MCG software to use the Clinical Indications to determine the appropriateness of admission to inpatient care.
  • Better able to utilize MCG software to apply the discharge planning resource.
  • Better able to utilize MCG software to use the Clinical Indications to determine the appropriateness of admission to the home care setting.
  • Better able to describe the format and features of the General Treatment Course.
  • Better able to utilize MCG software to identify discharge planning resources included in Home Care. I am better able to utilize MCG software to identify how to apply the Recovery Facility Care guidelines.
  • Better able to utilize MCG software to determine the appropriateness of care at the acute inpatient rehabilitation (IRF) and the subacute/skilled nursing facility (SNF) levels of care.
  • Better able to utilize MCG software to identify discharge planning resources included within Recovery Facility Care.