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Doody's Review ServiceReviewer: Tina M Snapp, BSN (University of Colorado Hospital)
Description: This is a book on comprehensive role definitions, explanations, and challenges affecting acute care facility case managers.
Purpose: The purpose is to describe the necessary tools needed to function in the world of managed care. Licensure, legal, and insurance issues are discussed. Historic and global information on case management and change implementation is included.
Audience: This book is directed at students and practicing case managers. It could also be used by physicians to help them understand the process of case management and enhance their understanding of regulatory requirements. All objectives are met by the author.
Features: A review of the essential elements of functioning as a facility case manager is provided. Legal issues pertaining to practice and reimbursement issues affecting discharge planning are well addressed. The author provides skills on how to navigate the managed care system and understand the decisions rendered by those organizations. Insurance issues are discussed in detail to to include reimbursement principles. Although the author touches on the ethical issues faced by case managers today, she could have included the position case and utilization managers are placed in to balance the reality of hospital financial issues and patient needs. It would have been beneficial to see the role of the payor case manager expanded and discussed.
Assessment: This book is better organized and more comprehensive that Powell's Advanced Case Management: Outcomes and Beyond (Lippincott Williams & Wilkins, 2000). The book reviewed here contains resources for the beginner, intermediate, and even advanced case manager. Very good definitions and pertinent information to function in today's healthcare system are addressed. Overall, this is an excellent resource for nursing students, floor nurses, hopsital managers, utilization managers, and practicing case managers. Extensive information and detail in each category is provided. A large amount of interrelated information, pertinent to daily job responsibilities, is well organized.