CASE MANAGEMENT
LATRYCE CRENSHAW
MHS 515
APRIL 27, 2014
MARIA HEWETT
CASE MANAGEMENT
CASE MANAGEMENT

What is Case Management? Case management refers to coordination of patient services on behalf of a person who may be considered case in different setting such as health care, nursing, rehabitation, social work, disability, insurance, employment and law. In today society medical case management referring to facilitation of treatment plans to assure the appropriate medical care is provided to disabled, ill or injured individual persons. Case management is one of the fastest growing segments of the healthcare industry and is critical in all areas of healthcare delivery, HMO’s, PPO’s, insurance companies, hospitals, and home health. As the government and private payers convert their systems form payment for treating illness to payment for preserving health, case managers provide and efficient, cost effective means to keep patients healthy and out of the hospitals.

Furthermore, healthcare delivery continues to become more individualized and treatment more complex, experienced case managers will continue to grow in demand. With appropriate education and training, all healthcare professionals can become Case Managers in the new future.

• Work collaboratively with the patient, physician, family/significant others, and healthcare

• Encourage clients to self-direct care, self-advocate, and make decision when appropriate and to

• Maximize efficiency in the use of available health care resources

• Maintain cost containment in the provision of services and ensure services are rendered timely

• Designate the expenditures of claims dollars and timely claim determinations

• Understand issues of cultural diversity underlying case management

Community Resources: Coordination and Delivery of Service

The case manager’s responsibly as well as community resources for patients at the local, state and national levels, such as alternatives to traditional home care. In addition, learn the steps needed for assessing case management services, including strategies for implementing, monitoring and coordinating th-e service delivery plan and evaluating the effectiveness of the techniques used.

Assessment: (1) Data Driven – collecting information (2) Outcome Focus (3) Basis for Development of a Plan

What the purpose? (1) Mission (2) Philosophy (3) Culture
External Assessment
(1) Market
(2) Needs
Internal Assessment
(1) Resources
(2) Abilities

A. DEMOGRAPHIC/
PERSONAL DATA:

Name: ( I like to be called)
Male or Female
DOB:
Age:
Marital Status:
Ethnicity:
Primary Language:
For interpretation, contact: Relationship: Ph:
Religious Affiliation:
Religious Support Contact/Phone

Room/Bed and Nursing Unit

A CASE MANAGEMENT
IDENTIFICATION INFORMATION:
Date of CM Referral
Type of Referral
Who Referred
Admit/Readmit date:
From:
Insurance:  Medicare  Medi - Cal  Military  VA Private:
Income:  VA  SSDI  SSA  SSI  SS  None Other:
Benefit Pending (Date of application):

Responsible party/Significant other contact list:

Name
Address
Phone Number
(Home, Work, Cell)
Relationship
Author- ization  
 

 
 
 
 
 

 
 
 
 
 

 
 
 
 
 

 
 
  Code Status:
 No Code  Full Code  Unknown  Full Care  Comfort Care
B ACTUAL CASE MANAGEMENT
MEDICAL HISTORY

C RECENT MEDICAL HISTORY
RECAP OF EVENT FOR THIS ILLNESS ONLY (EVENTS LEADING TO POINT WE ARE AT NOW`

D PREVIOUS MEDICAL CARE
PRIOR MEDICAL/SURGICAL HISTORY INCLUDING DIAGNOSIS, MEDICATIONS, DATES, PHYSCIANS, OUTCOMES:

E IMPORT ADT
Import Medical Status
Develop functional status
1. Mobility - Expand, cane, walker. Crutches, and/or wheelchair etc..
2. Activity
3. ‘’