Case Management: A Practical Guide to Success in Managed Care / Edition 2

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The Second Edition of this comprehensive "how to" text has been completely revised and updated. This text outlines the basics of case management and illustrates some of the pitfalls encountered in the field of case management. The book provides information on the new Case Management Standards, supplies standard definitions and guidelines of case management for the practicing case manager, and presents information on caring for clients in a wide variety of health care settings. An entire chapter is devoted to case management characteristics, job responsibilities, and essential skills for most case managers in this challenging field. New to this edition—a chapter on Quality Reviews and Risk Management with a strong emphasis on Continuous Quality Improvement (CQI), separate chapters covering ethical and legal issues, and various case studies.

A Brandon-Hill Recommended Title.

The book contains black-and-white illustrations.

A comprehensive "how to" text for practicing nurses learning case management. This text outlines the basics of case management and illustrates some of the pitfalls that can make the field so challenging. This book can be used both as a teaching tool and as a useful reference on pertinent issues.

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Editorial Reviews

Doody's Review Service
Reviewer: 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.

3 Stars from Doody
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Product Details

  • ISBN-13: 9780781718837
  • Publisher: Lippincott Williams & Wilkins
  • Publication date: 1/28/2000
  • Edition description: Second Edition
  • Edition number: 2
  • Pages: 544
  • Product dimensions: 6.10 (w) x 9.10 (h) x 1.10 (d)

Table of Contents

Pt. I Introduction to Case Management
1 Overview of Case Management 2
2 Case Management Job Responsibilities and Essential Skills 55
3 Credentials, Organizations, Guidelines, and Standards 95
Pt. II Basic Concepts in Case Management
4 Insurance 128
5 Utilization Management 166
6 Legal Issues in Case Management 237
7 Ethical Issues and Dilemmas 296
8 Quality Reviews and Risk Management 328
Pt. III The Case Management Process
9 Discharge Planning: Understanding Levels of Care and Transfers 354
10 The Case Management Process 410
Pt. IV Practical Applications
11 Job Stress Versus Success Factors in Case Management 468
12 Case Management by Proxy: Case Studies 489
Glossary 501
Index 511
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Customer Reviews

Average Rating 4
( 2 )
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Sort by: Showing all of 2 Customer Reviews
  • Anonymous

    Posted January 8, 2005

    Good resource for case managers

    Very good book on case management and the processes involved in facilitating excellent and appropriate care. Good for workmen's comp or insurance case managers, however not enough impact on actual patient teaching strategies and how to impact the health of an individual through personal contact or telephonic monitoring and support. I still give this book an 'A' for the clear, concise rationale into case managment. LB. BSN, RN, CCM

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  • Anonymous

    Posted November 26, 2004

    Good Reference for CCM Certification

    I found this to be a very helpful resource in preparing for the CCM exam.

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