When people do not have the support systems in place, or the support system is overwhelmed with the care of their loved one and don’t know the resources or where to turn for help, a professional case manager can be a real asset. The Case Management Society of America defines case management as “a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health care through communication and available resources to promote quality, cost effective outcomes”.
A case manager typically has a background in nursing or social work. A case manager assesses the situation and then walks the client and family through the overwhelming process of care from the catastrophic event, or chronic health condition to improve care, and promote optimal wellness in a timely manner. By hiring someone who knows the system, not only will the case manager connect the client with the appropriate care providers, but will follow up and make appropriate recommendations to changes in care as immediate needs change decreasing unwarranted medical visits, preventing hospitalizations. A case manager has the knowledge and skill to get the person to maximum medical improvement (MMI) faster.
“The underlying premise of case management is based on the fact that when an individual reaches optimum level of wellness and functional capabilities, everyone benefits; the individual being served, their support system, the healthcare delivery system, and various reimbursement services” (CMSA, nd.).
A good case manager can trouble shoot issues in care and resolve barriers to care. When I am asked by litigation attorneys if plaintiff or defense would benefit in a referral to a professional case manager, the answer is both. The case manager is there for the client to make sure the appropriate care is given and followed through with and can get the person to a stable condition faster. Unnecessary care is avoided and necessary care is followed through and it should all be documented by the professional case manager as proof of the care as well as the outcomes and goals reached.