Case Manager's Survival Guide Winning Strategies for Clinical Practice

ISBN-10: 081511771X

ISBN-13: 9780815117711

Edition: 1998

List price: $37.95
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This practical, "hands-on" guide includes vital information every case manager and administrator of a case management program need to be successful. A useful resource for working in the changing face of healthcare, it addresses case managers in all settings with an emphasis on nurse case managers and their role in providing patient care and containing costs. Focusing on the "nuts and bolts" aspects of case management, it discusses the operations of case management programs based on the authors' first hand experiences.
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Book details

List price: $37.95
Copyright year: 1998
Publisher: Elsevier - Health Sciences Division
Publication date: 4/9/2002
Binding: Hardcover
Pages: 288
Size: 7.50" wide x 9.25" long x 0.88" tall
Weight: 1.540
Language: English

Introduction to Case Management
Using This Guide
Healthcare Industry in Crisis
History of Case Management
Changes in Reimbursement: The Driving Force Behind Case Management
Continuous Quality Improvement and Case Management
Nursing Case Management
Early Community-Based Case Management
History of Critical Pathways
Case Management Plans Today
Multidisciplinary Care Planning
Choosing a Case Management Tool
Physician Support
Benefits of Case Management
Interdisciplinary Team
Change Process
Managed Care
Financial Reimbursement Systems
Origins of the Prospective Payment System: An Overview
Use of Documentation
Impact of DRGs on the Healthcare Industry
Use of DRGs Today
APCs: Medicare's Outpatient Prospective Payment System
Home Care Prospective Payment System
Inpatient Rehabilitation Facility Prospective Payment System
Long-Term Care Reimbursement (Skilled Nursing Facility)
Government Programs
Third-Party Payers/Managed Care Organizations
Managed Care and Its Stages of Development/Maturation
Integrated Delivery Systems as a Response to Managed Care
Other Health Benefit Plans
Proactive Tactics to Counteract the Effects of Managed Care
Case Management Models
Types of Case Management
Hospital-Based/Acute Care Models
Community-Based Case Management Models
System Models
Chronic Care Case Management
Long-Term Care Case Management
Managed Care Models and Case Management
Designing Case Management Models
Setting up the Case Management Program
Role of the Case Manager
Case Management Process
Various Roles Played by Case Managers
Roles of the Case Manager in Varied Settings
The Social Worker as Case Manager
The Advanced Practice Nurse as Case Manager
Utilization Management
Relationship Between Utilization Management and Case Management
The Review and Certification Process
Criteria Used for Utilization Review
Criteria Used for Utilization Review--InterQual
The Continuum of Care
Applying ISD Criteria
Milliman & Robertson
Denials and Appeals
Peer Review Organizations
What Case Managers Need to Know About Managed Care Contracts
Working with Patient Accounts
Reporting Utilization Management Data
Transitional Planning and Case Management
Transitional Planning or Discharge Planning
The Continuum of Care
The Case Manager's Role in Transitional Planning
Transferring Patients to Other Facilities
Disease Management
Evolution of Current Disease Management Programs
Disease Management and Case Management
Impact of Disease Management on Quality and Cost
Designing Disease Management Programs
Putting It All Together: The Disease Management Template
St. Elizabeth of Hungary Clinic's Disease Management Program
Skills for Successful Case Management
Nursing Process
Leadership Skills and Functions
Communication and Other Interpersonal Skills
Communication Paths
Successful Leaders
Case Manager's Documentation
Importance of Documentation
Role of Case Managers in Documentation
Charting by Exception
Documenting Patient Education
Case Presentation
Hiring Case Managers: Role of the Candidate and the Interviewer
Characteristics Looked for in Potential Candidates for the Case Manager's Role
Interviewer's Role
Follow-up Interviews
Curricula and Certification in Case Management
Background of Case Management Educational Programs
Case Management Certificate Programs
Case Management Noncertificate Programs
Case Management Degree Programs
Certification in Case Management
The Commission for Case Manager Certification
The American Nurses Credentialing Center's Case Management Certification
Forecasting the Future of Case Management Credentialing
Developing Case Management Plans
Overview of Case Management Plans
Types of Case Management Plans
Process of Developing Case Management Plans
Patient and Family Case Management Plans
Strategies for Physician Participation and Buy-In
Organizing the Work of the Interdisciplinary Team
Quality Patient Care
Importance of Quality
Meaning of Quality
Characteristics of Quality
Setting the Standards for Quality
A Historical Review of Quality
Using Structure/Process/Outcomes to Measure Quality
Quality Categories of Organizational Values
Case Management and CQI
Consumer/Patient Satisfaction
Cost/Quality/Case Management
Case Management and Outcomes Management
Measuring the Effectiveness of Case Management
Outcomes as Indices of Quality
Outcomes Not Directly Related to the Patient's Health
Outcomes Related to Patient Health
Clinical Outcomes
Patient Care Variances
Outcomes Management and Outcomes Classification
Organization-Specific Outcome Measures--Evaluating the Department of Case Management
Organization-Specific Outcome Measures--Evaluating the Case Manager
National Quality Indicators
Report Cards
Linking JCAHO to Case Management
Overview of the JCAHO Standards
Continuous Self-Evaluation and Improvement
Relationship of Case Management to JCAHO Standards
Case Management and Root Cause Analysis
Documentation Standards
Interdisciplinary Approach to Patient Care
Legal Issues in Case Management
Case Management Systems, the Case Manager, and the Legal Process
Standards of Care
Informed Consent
Legal and Ethical Dilemmas for the Case Manager
Case Management Plans
Patient Confidentiality
Application of Legal Concepts to Case Management Practice
Sources of Anxiety for Today's Case Managers
Basis for Assigning Liability in Case Management
The Difference Between Negligence and Malpractice
Establishing the Standard of Care for the Case Manager
Case Management "Hot Spots" That Have Already Received Legal Review
Role of the Medical Record Review in a Lawsuit
Professional Misconduct
Protecting the Case Manager in This Litigious Society
Ethical Issues in Case Management
Managed Care and Patient Advocacy
Case Management and New Ethical Challenges
Maintaining Ethical Integrity
The Deliberative Framework
Organizational Ethics
Using the Internet for Case Management
The Internet
Patient and Family Education Resources
Other Uses of the Internet by Case Managers
Assessing the Quality of Health Information on the Internet
Case Management-Related Web Sites
Community Nurse Case Management Problem List and Plan of Care
Community Nurse Case Management Intervention Flow Sheet and Problem Rating Scale for Outcomes
Community-Based Wound Care Pathway and Flow Sheet
Home Care Plan for Congestive Heart Failure and Hypertension
Subacute Care
Clinical Guideline for Short-Term Subacute Admissions
Referral Assessment Form
Subacute Data Collection Tool
Long-Term Care Resident Assessment Instrument Case Study and Care Plans
Preprinted Order Sets
Documentation Guides for Physicians
Case Manager--Inpatient
Case Manager--Admitting Office
Case Manager--Emergency Department
Case Manager--Community
Physician Advisor
Guide for a Case Manager's Competency-Based Performance Appraisal
Performance Management Form--Case Coordinator
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