Medical Case Management is the coordination of medical services in order to achieve quality, timely and cost-effective solutions. The basic premise of medical case management is simple. It is the delivery of the right services at the right time. Done correctly, case management works because it helps ensure top quality care delivered in a timely fashion. It allows the use of appropriate specialized services that maximize recovery. It accomplishes this by using communication and available medical and community resources to promote quality outcomes. Services are coordinated with all team members, including, but not limited to the injured person, family, physician(s), therapists, home care agency, durable medical equipment vendor, builder, insurance adjuster, etc.
From pediatrics to geriatrics, it is the role of the case manager to assess the needs of each individual and assist in developing a plan to meet each person's unique needs. Our role can be as general or specific as you request, including but not limited to the following:
• Selecting physicians.
• Coordinating services between physicians of varying specialties.
• Coordinating services between physicians and other health professionals (i.e., therapists).
• Overseeing therapy involvement (for effectiveness).
• Determining equipment needs.
• Locating transportation services.
• Locating home health agencies / nurses / aides.
• Obtaining appropriate services for children / students in school.
• Assisting with return to work issues.
• Home evaluation.
• Coordination of home modification needs.
• Identifying residential options.
• Overseeing residential/therapeutic services.
• Coordinating attendant care issues.
• Insurance issues.
• Coordination of benefits.
The Case Management Society of America (CMSA) defines case management as a collaborative process that assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet an individual's health needs, it uses communication and available resources to promote quality, cost-effective outcomes.
