Fundamentals of Case Management: Guidelines for Practicing Case Managers / Edition 1

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Overview

Developed for professionals and firms who are new to the growing field of insurance-based or external case management, this practical handbook focuses on case management in accident/health and property/casualty insurance including workers' compensation. It presents a step-by-step approach to assist both new and experienced case managers. For the novice, it provides information on roles and responsibilities of a case manager, how to start a case management program, a functional description of insurance systems, and information on hiring and training case managers. More experienced case managers will benefit from discussion of effective marketing to help increase business, better supervision of case managers to maintain quality, and fee negotiation for better cost savings through case management.

* Covers all key aspects of healthcare delivery systems, both inpatient and outpatient.
• Addresses cutting-edge issues such as the future of case management, disease management, risk management, telephonic vs. onsite case management, and vocational rehabilitation.
• Provides a detailed unit on how to set up and operate an effective case management program.
• Includes useful appendices that provide sample forms, report formats, checklists, and examples of criteria that eliminates the need to develop new case management tools.

The book contains no figures.

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Editorial Reviews

Doody's Review Service
Reviewer: Roberta M. Conti, PhD, RN, CCM (George Mason University College of Health and Human Services)
Description: This book focuses on case managers working for third party payers and insurance companies.
Purpose: Its primary purpose is to provide definitive practice guidance for payer-based case managers. Proposed objectives are to provide training, program establishment guidelines, and comprehensive and fundamental information. These objectives attend to the core competencies required of case managers in payer-based systems. The content is addressed in a clear, comprehensive manner.
Audience: The authors' primary audience is novice case managers working in the payer-based model of case management. Secondary audiences include experienced case managers and insurance professionals. This book could be used in continuing education and in academic courses.
Features: The authors comprise an interdisciplinary group representing nursing, vocational rehabilitation counseling, and clinical psychology. Their educational preparation, credentials, and experience indicate they are credible experts. Illustrations are organized across four appendixes and include example forms and communications used in case work, as well as example practice criteria. They provide good examples for novice case managers. However, the formats do not easily allow for application of information technology in data collection. References are current and include appropriate publications. The table of contents clearly identifies major sections and subsections. Heading structures assist the reader to easily identify content focus. The book's softbound cover, size, and shape make it easy to use. Unique features include a well-done glossary, attention to vocational rehabilitation, chapter end suggested readings, and use of a cumulative numerical footnote system.
Assessment: This is a well written, payer-based practice guide of particular usefulness to novice case managers. Comparative examples are an especially effective writing technique. The book is comprehensive in its scope, including topics like ethical practice. Practicing case managers in payer-based models, insurance professionals, libraries, and educators who wish to use it as a supplemental text should buy it.
Roberta M.Conti
This book focuses on case managers working for thirdparty payers and insurance companies. Its primary purpose is toprovide definitive practice guidance for payer-based case managers. Proposed objectives are to provide training, program establishmentguidelines, and comprehensive and fundamental information. Theseobjectives attend to the core competencies required of case managers inpayer-based systems. The content is addressed in a clear,comprehensive manner. The authors' primary audience is novice casemanagers working in the payer-based model of case management. Secondary audiences include experienced case managers and insuranceprofessionals. This book could be used in continuing education and inacademic courses. The authors comprise an interdisciplinary grouprepresenting nursing, vocational rehabilitation counseling, andclinical psychology. Their educational preparation, credentials, andexperience indicate they are credible experts. Illustrations areorganized across four appendixes and include example forms andcommunications used in case work, as well as example practice criteria. They provide good examples for novice case managers. However, theformats do not easily allow for application of information technologyin data collection. References are current and include appropriatepublications. The table of contents clearly identifies major sectionsand subsections. Heading structures assist the reader to easilyidentify content focus. The book's softbound cover, size, and shapemake it easy to use. Unique features include a well-done glossary,attention to vocational rehabilitation, chapter end suggested readings,and use of a cumulative numerical footnote system. This is awellwritten, payer-based practice guide of particular usefulness to novicecase managers. Comparative examples are an especially effectivewriting technique. The book is comprehensive in its scope, includingtopics like ethical practice. Practicing case managers in payer-basedmodels, insurance professionals, libraries, and educators who wish touse it as a supplemental text should buy it.

3 Stars from Doody
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Product Details

  • ISBN-13: 9780815124986
  • Publisher: Elsevier Health Sciences
  • Publication date: 8/15/1997
  • Edition number: 1
  • Pages: 272
  • Product dimensions: 7.30 (w) x 9.28 (h) x 0.52 (d)

Table of Contents

PART I: INTRODUCTION TO CASE MANAGEMENT, THE HEALTH CARE DELIVERY SYSTEM, AND INSURANCE · Case Management: History, Overview, Concepts, and Models · The Role and Qualifications of the Case Manager · The Health Care Delivery System, Managed Care, and Case Management · Insurance: General Principles and Terminology · Lines of Insurance Coverage · Legal Issues in Case Management · PART II: PRACTICAL ASPECTS OF CASE MANAGEMENT · Case Identification, Referral, Screening, and Authorization · On-site versus Telephonic Case Management · Initial Assessment, Interviewing, and Counseling Skills · Working the Case · Writing Case Management Reports · Creativity in Researching Medical and other Issues During Casework · PART III: SETTING UP A CASE MANAGEMENT PROGRAM · Marketing Case Management· Developing a Management Plan for Your Company · The Case Management Office or Unit · Hiring, Training, and Supervision of Case Managers · Risk Management in Case Management · Internal Quality Control · Outcomes Management · PART IV: RELATED ASPECTS OF CASE MANAGEMENT · Vocational Rehabilitation · Vocational Evaluation · The Americans With Disabilities Act · Client Placement and Provider Negotiations · Ethics in Case Management · Disease Management · Addressing Cross-Cultural Issues · Future of Case Management · Appendix 1: Examples of Criteria · Case Management Prenotification List· Information from Intake · Information from Health Coordinators · Clinical Screening Criteria · Generic Screening Criteria For Opening Case Management Cases · Criteria for Determining Order of Precedence for Case Management Services · Appendix 2: Developing and Using Letters and Forms for Casework · Examples of Case Management Forms · Report Writing Formats · Examples of Forms Letters · Appendix 3: Vocational Rehabilitation · The Vocational Rehabilitation/Evaluation Process · Vocational History Form · Job Analysis Form · Labor Market Survey Form · About the Dictionary of Occupational Titles (DOT) · About the Classifications of Jobs (COJ) 1992 Revision · Definitions from the DOT · Physical Capacities Evaluation (PCE) Form · Appendix 4: Case Management Test · Glossary · References

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Sort by: Showing 1 Customer Reviews
  • Anonymous

    Posted July 28, 2000

    Great reading for new case managers

    This book has been a blessing. I'm new in the case managing arena. This book has helped me fine tune techniques. I combine what I learn on the job and what I read.

    Was this review helpful? Yes  No   Report this review
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