Case management coordinates care for individuals in health, mental health or social care systems, linking patients with community and health care resources to ensure efficient use of resources. Case managers have medical or social work backgrounds and may work in health insurance or managed care industries.
Case management is an approach to coordinate care for individuals in health, mental health or social care systems. The term can be used to describe the coordination of care and services within the insurance industry, but it can also describe an approach to linking medical and mental health patients with community and health care resources. The goal of case management is to ensure that people in need of treatment receive it and that insurance, medical and social resources are used efficiently.
Many people in need of health care services, especially mental health care services, require care that is beyond the scope of what health care and medical systems can provide. However, it is often critical to a patient’s well-being to ensure that she has a place to live, food to eat, and adequate care at home. Without these supports, the effectiveness of health care can be undermined, sometimes to the point of ineffectiveness. Case management provides vulnerable patients with a point person who can connect the patient with community resources and family in hopes of better understanding their situation and needs. Depending on the patient’s situation, the healthcare facility or an outside agency may provide the patient’s primary case management services.
Case management services are provided by individuals who typically have medical or social work backgrounds. Many medical case managers are nurses, although some are social workers. In social service agencies, case managers may also be social workers, although some may not have any particular mental health credentials. In some countries, such as the United States, it is possible for a case manager to acquire certification through a professional case manager society.
In the health insurance and managed care industries, a case manager may work with people who have serious health problems to ensure they receive appropriate and affordable care. The case manager can work with service providers to establish appropriate rates and payments for services, refer the client to specialists, and help the client make decisions about her care. Some health insurance companies routinely appoint case managers for policyholders with serious or chronic conditions. Employers can also use the services of case managers who can help the organization work with employees who have long-term medical needs and who can support employees in self-care and ensure that the organization can find appropriate solutions for the needs of the employee.
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