Procedures of Case management in Nursing

With the onset of Medi heraldic bearing and Medicaid reimbursement using diagnostic-related groupings in the mid-1980s, health c are providers began to man mount up length of stay, physician rule patterns, rehabilitation, and outpatient services, as reimbursement rules were tightened. Discharge planning became a legally mandated serve well for hospitals to participate in Medi contend and medicaid programs in 1994. theme centering provided by nursing initiatives became an effective way to meet these goals.

The emergence of managed care and HMOs created a need for lesson managers in inpatient and outpatient/primary coil care (Zander, 2002, 59). The developing of disease management programs by pharmaceutical companies, and then by payers and providers also created a need for draw shift managers. This new need led to the development of the Case Management Administrator Certification program, which tests seven core components which are tested for competency: identifying at-risk populations; assessment of clinical system components; development of strategies to manage at-risk populations; leadership for change; market assessment and strategic planning; human resource management; and program rating through outcomes management. As hospitals recognize the difficulties involved in empty planning for patients with comorbidities and chronic conditions

LoBianco, mare S., Mills, Mary Etta, Moore, Harriett W. (1996). A model for case management of naughty cost Medicaid users. Nursing Economics, 14(5): 303-308.

White, Randee Breiterman. (1996). Epoetin alfa - focus on nursing case management: case study of the anemic patient. ANNA Journal, 23(3):326-329.

The State of medico employs case management to try and control the spiraling cost of Medicaid payments (LoBianco, Mills and Moore, 1996). The plan focuses on "high-risk" Medicaid recipients under age 65, and uses experienced public health community nurses as case managers for one division of its plan, and private sector case managers in the other.

The types of cases served by these case managers include high-risk pregnancy, pediatric asthma attack and lead poisoning, diabetes, AIDS, COPD, great dealcer, and sickle cell disease. Case managers take up the self-confidence to redesign the benefit plan to suit the individual patient, within program financial guidelines.

In hospitals, case managers often have the merged roles of utilization review and discharge planning, while in the insurance industry, they confirm medical necessity and recommend confidence of needed services (Kuntz, 1999). Case managers also operate independently, and can provide a full scope of services across a variety of settings (169). As a discipline, case management requires specialized skills and knowledge of how various medical, insurance, government, and corporate processes affect healthcare delivery. Case managers must be aware of the types of settings in which care is delivered and what care is available, and be able to match these to the needs of patients. They must keep current with changes in federal and state lawmaking and how they impact healthcare delivery and the options available to patients.

Lynn and Kelley (1997) carried out a study to assess the effects of case management on p
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