Exam : Case Management

What is a case manager accountable for? What are case managers advocates for? What are 5 key functions and responsi- bilities of a case manager? A nurse case manager must encompass a knowledge of the health care environ- ment with regards to what 4 aspects? In the clinical setting, what type of as- sessment does the case manager per￾form? What type of planning is performed by the case manager in a clinical setting? What type of implementation is per￾formed by the case manager in the clini- cal setting? What type of evaluations do case man- agers perform in the clinical setting? What are 4 roles of the case manager in managing business/financial concerns? The case manager is accountable for col￾laboratively facilitating the assessment, planning, implementation and evaluation of care coordination and care transitions in the acute care setting. Nurse case managers serve as advo- cates for options and services to meet the patient and family needs, while pro- moting quality, cost effective outcomes for the assigned case types. 1. Coordination and facilitation of care 2. Utilization and resource management 3. Tracking of avoidable delays 4. Transitional and discharge planning 5. Quality and process improvement 1. Clinical 2. Business/Financial 3. Managerial 4. Professionalism Patient and family interview and review of medical record Consult with the physician, health care team and patient/family - develop plan of care to facilitate a timely discharge /transition plan Implements the plan of care in a timely manner to facilitate accomplishment of goals and interventions. Reassessment for any decline in status and plan revisions 1. Ensure that the level of care is appro- priate and services are medically neces- sary 2. Proactively identify delays in care, de￾lays in discharge and risk of readmission Exam #1: Case Management 2 / 12 What are 5 managerial duties of the case manager? What are 5 key points that the case man- ager is responsible for in instituting professionalism in the profession? What is a clinical pathway? What are clinical pathways used to achieve? What term has Cone Health renamed their clinical pathways and why? 3. Maintain competence of utilization re- view (inpatient vs. observation status) 4. Document avoidable delays/days 1. A nurse case manager must display leadership skills in decision making and problem solving 2. Must actively participate in Interdis- ciplinary Team Meetings and maintain open communication with physicians 3. Strive to make productive use of time through the setting of priorities 4.Foster an environment of professionalism 5. Utilize the Chain of Command effectively in addressing complex/unusual sit- uations 1. Integrate high ethical standards and core values 2. Hold self and others accountable 3.Perform work in an accurate and timely manner 4. Serve as a role model and mentor 5. Maintain current clinical knowledge and leadership skills A clinical pathway is a map of clinical practice for a particular diagnosis - also known as care maps. It is a timeline for patient care activities which is used by all disciplines Clinical pathways have emerged as a popular method to standardize care while reducing costs and improving quality of care Cone Health has renamed them to "Patient Care Plan" in an attempt to make them more individualized