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To be a hospital Case Manager requires experience in the hospital setting, typically as a nurse or a social worker. Additional skills specific to case management are learned in the role. Advanced certification is available to Hospital Case Managers through the Accredited Case Manager (ACM) Certification, offered by ACMA.
Medical case management is a collaborative process that facilitates recommended treatment plans to assure the appropriate medical care is provided to disabled, ill or injured individuals. It is a role frequently overseen by patient advocates .
The case manager becomes an effective facilitator or enabler by use of self, understanding the social systems, the etiology of needs, and functioning of the clients. Moore in 1990s said that a case manager should possess the clinical skills of a psychotherapist and the advocacy skills of a community organizer. [10]
Primary Care Case Management (PCCM) is a system of managed care in the US used by state Medicaid agencies, in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment. [1]
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
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Case management (US health system), a specific term used in the health care system of the United States of America; Medical case management, a general term referring to the facilitation of treatment plans to assure the appropriate medical care is provided to disabled, ill or injured individuals; Legal case management, a set of management ...
In short, a medical social worker provides services in three domains: intake and psychosocial assessment, case management and supportive therapy, and discharge planning and ongoing care that extends after hospitalization. They are also involved in patient and staff education, as well as with policy research for health programs. [4]