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Case Management in Healthcare

The Important Role of Case Management in Healthcare

Analysts expect medical case management to reach a market size of over $5 billion by 2028. Case management in healthcare is crucial for handling patient cases appropriately. 

Have you considered becoming a case manager?  Are you unsure what the exact purpose of case management in healthcare is?

The following guide will explain what the field is, the duties involved, and why it’s so important. Read on to discover more about medical case management and how it works.

What Is Case Management in Healthcare?

Medical Case managers review a patient’s specific needs. Then, they direct the patient to appropriate services and resources. For example, a case manager often provides referrals to doctors. 

Case management typically produces better patient results and improved adherence to medical advice. It also helps improve the patient’s self-management of injuries and illnesses.

Hospital Case Management

Hospital case managers are usually nurses that conduct reviews and discharge plans. The reviews ensure that patients get proper medical care in the correct setting.

Planning a discharge involves deciding the patient’s needs after leaving the hospital. Hospital case managers often handle intricate care needs across multiple providers.

They also review the patient’s health insurance plan to provide the best care and price. Case managers also help patients avoid claim denials. They can even negotiate coverage benefits with the insurer.

Hospital case managers set up home visits from a nurse after a patient leaves. They also help lineup rehabilitation facilities if needed.

Case managers typically use software to manage documents and billing. You can visit here for more information about the software.

Home Health Case Management

Home healthcare case managers provide patients with hands-on care. They also coordinate services with other healthcare teams and caregivers.

These managers work with insurance companies, physicians, nurses, and other home health support. Home case managers create a plan of care to be approved by a physician.

Many home health case managers are nurses but that’s not always the case. Patients should check if their plan includes nursing care or basic assistance.

Health Insurance Case Management

Health insurance companies use case managers to get information from hospital case managers. They also gather information from social workers, physicians, and other providers.

Insurance case managers might even see patients in the hospital depending on their insurer and location. Their main goal is to get the patient the best care at the most economical price.

Health insurance companies often use case managers for chronic diseases. For example, managers might help people with HIV handle medications and blood tests. The case manager also notes any side effects or complications.

Case Manager Requirements

Hospital case managers need to have a license or certification in health or human services. Examples include nursing and social work.

They also need 12 to 24 months of field experience before getting certified. Keep in mind that requirements vary depending on location.

Understanding Healthcare Case Management

Now you know why case management in healthcare is so important to patient care. Case managers help clients achieve better results with careful planning.

Check out the rest of our blog for other informative and fascinating articles.