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Managed Care And Case Management
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Book Synopsis Case Management by : Suzanne K. Powell
Download or read book Case Management written by Suzanne K. Powell and published by Lippincott Williams & Wilkins. This book was released on 2000 with total page 548 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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. New to this edition--chapters focusing on Quality Reviews and Risk Management with a strong emphasis on Continuous Quality Improvement (CQI), ethical and legal issues, and various case studies.
Book Synopsis Nursing Case Management by : Suzanne K. Powell
Download or read book Nursing Case Management written by Suzanne K. Powell and published by Lippincott Williams & Wilkins. This book was released on 1996 with total page 422 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Managing Managed Care by : Institute of Medicine
Download or read book Managing Managed Care written by Institute of Medicine and published by National Academies Press. This book was released on 1997-04-21 with total page 394 pages. Available in PDF, EPUB and Kindle. Book excerpt: Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.
Book Synopsis A Practical Guide to Acute Care Case Management by : Colleen M. Morley DNP CCM CMAC CMCN ACM-
Download or read book A Practical Guide to Acute Care Case Management written by Colleen M. Morley DNP CCM CMAC CMCN ACM- and published by . This book was released on 2021-12-15 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis The Case Manager’s Handbook by : Catherine M. Mullahy
Download or read book The Case Manager’s Handbook written by Catherine M. Mullahy and published by Jones & Bartlett Learning. This book was released on 2016-05-23 with total page 769 pages. Available in PDF, EPUB and Kindle. Book excerpt: Written by renowned author Catherine M. Mullahy, The Case Manager’s Handbook, Sixth Edition is an indispensable guide for case managers. Presented in an accessible and conversational style, this practical resource helps case managers learn the fundamentals, study for the Certified Case Manager (CCM) exam, and advance their careers after the exam. Completely updated and enhanced with information on the latest developments affecting case management, it reflects the rapidly changing healthcare landscape, including the significant effects of the Affordable Care Act (ACA). The Sixth Edition includes new chapters on pediatric case management, workers’ compensation case management, key factors driving today’s healthcare system, the case manager’s role in the era of value-based health care, case management and healthcare provider strategies for managing the high-risk or high-cost patient, and transformative healthcare approaches for the millennial generation.
Book Synopsis Case Management by : Suzanne K. Powell
Download or read book Case Management written by Suzanne K. Powell and published by Lippincott Williams & Wilkins. This book was released on 2018-02-26 with total page 914 pages. Available in PDF, EPUB and Kindle. Book excerpt: Prepare for a new career as a case manager—or just upgrade your skills to a whole new level—with the newly updated Case Management: A Practical Guide for Education and Practice, 4th Edition. Ideal for case management certification (CCMC) exam preparation, this is a thorough review of the case manager’s many roles and skills, from acute to post-acute care. Whether you are a nurse transitioning to case management or already active in it, this is your road map to coordinating successful patient care, from hospital to home. Build a strong case management career foundation, with expert, evidence-based direction: NEW chapter on case manager orientation programs that offers orientation checklists, competency assessment, and learning profiles, with available online tools NEW topics on current practice issues and developments, including the impact of the Patient Protection and Affordable Care Act and value-based care NEW content on experiential, problem-based learning—learning practices, training programs, case management team professional development Offers in-depth, evidence-based guidance on: The case manager’s roles, functions, and tasks Key concepts—quality management and outcomes evaluation, legal and ethical considerations, case management process, utilization management, transitions of care The role of the nurse case manager versus social worker role Strategies that ensure effectiveness of case management models Coordinating care, protecting privacy and confidentiality, health insurance benefit analysis, practice standards The Case Management Code of Professional Conduct, accreditation agencies and standards, specialty board certifications Management of resources and reimbursement concepts Case management in various settings—acute care, emergency department, admissions, perioperative services, disease management, insurance case management, palliative care, end-of-life care, hospice, home health care, physician groups, public health/community-based care, rehabilitation Ideal preparation for the CCMC exam—offers a large portion of CCMC exam content—and for Continuing Education Unit (CEU) for Case Management study A must-have desk reference that offers plentiful case studies—considered to be “the bible” of case management
Book Synopsis The Case Manager's Handbook by : Catherine M. Mullahy
Download or read book The Case Manager's Handbook written by Catherine M. Mullahy and published by Jones & Bartlett Publishers. This book was released on 2013-06-20 with total page 805 pages. Available in PDF, EPUB and Kindle. Book excerpt: Written by renowned author Catherine Mullahy, The Case Manager’s Handbook, Fifth Edition is the ultimate how-to guide for case managers. This practical resource helps case managers build fundamentals, study for the Certified Case Manager (CCM) exam, and most importantly, advance their careers after the exam. Written for all professionals in all practice settings in case management, it uses real-life examples and an easy-to-read, conversational style to examine the case management process while presenting practical procedural information. An excellent daily reference and training guide for new case managers and seasoned professionals in various setting, The Case Manager’s Handbook, Fifth Edition is the “go-to” resource for facing the day-to-day challenges of case management, especially as the nation navigates through the many changes introduced by the landmark Patient Protection and Affordable Care Act. Significantly updated and revised, it contains eight new chapters: * Hospital Case Management: Changing Roles and Transitions of Care * Patient Centered Medical Home, ACOs, Health Exchanges * Evidence-Based Practice * Public Sector Reimbursement * Predictive Modeling * Pain Management * Health Technology, Trends, and Implications for Case Managers * The Affordable Care Act of 2010: Implications for Case Managers Included with each new print book is an Access Code for a Navigate Companion Website for students with objectives, multiple choice questions, and bonus appendices.
Book Synopsis Essentials of Managed Health Care by : Peter Reid Kongstvedt
Download or read book Essentials of Managed Health Care written by Peter Reid Kongstvedt and published by Jones & Bartlett Learning. This book was released on 2003 with total page 918 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis CMSA Core Curriculum for Case Management by : Hussein M. Tahan
Download or read book CMSA Core Curriculum for Case Management written by Hussein M. Tahan and published by Lippincott Williams & Wilkins. This book was released on 2016-07-05 with total page 862 pages. Available in PDF, EPUB and Kindle. Book excerpt: The fully updated CMSA Core Curriculum for Case Management, 3rd edition, is the definitive roadmap to an informed, effective, collaborative case management practice. This comprehensive, expertly-written guide provides those directly or indirectly involved in case management with information about best practices, descriptions of key terms, essential skills, and tools that fulfill the current Case Management Society of America’s (CMSA) standards and requirements. Addressing the full spectrum of healthcare professional roles and environments, this is both a crucial certification study guide and vital clinical resource for the case management professionals in all specialty areas, from students to veteran case managers. This unique resource provides the core knowledge needed for safe, cost-effective case management with the following features ... NEW text boxes highlighting key information and vital practices in each chapter NEW and updated Standards of Practice implications in each chapter NEW and updated content on transitions of care, community-based care, care coordination, Value-Based Purchasing, ethics and social media, the impacts of health care reform, and digital technology NEW and updated content on accreditation in case management NEW chapter that lists key additional resources, by topic Official publication of the Case Management Society of America, connecting CMSA core curriculum to current CMSA Standards of Practice Easy-to-grasp, detailed topical outline format for quick scan of topics Complete, updated core knowledge required of case managers, with expert descriptions and direction on areas including: Case management roles, functions, tools, and processes Plans, clinical pathways, and use of technology Transitional planning Utilization management and resource management Leadership skills and concepts Quality and outcomes management; legal and ethical issues Education, training, and certification Health care insurance, benefits, and reimbursement systems Practice settings and throughput Interdisciplinary teams’ needs in: hospitals, community clinics, private practice, acute care, home care, long-term care and rehab settings, palliative care, and hospice settings Up-to-date guidance on case management specialty practices, including: nursing, life care planning, workers’ compensation, disability management, care of the elderly, behavioral health, transitions of care, subacute and long-term care, utilization review/management, primary care and medical/health home, and more Essential content for academic reference, training, certification study, case management models design, performance or program evaluation
Book Synopsis Managed Care and Case Management by : Cheryl A. May
Download or read book Managed Care and Case Management written by Cheryl A. May and published by . This book was released on 1996 with total page 44 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Case Studies in Nursing Case Management by : Suzanne Smith Blancett
Download or read book Case Studies in Nursing Case Management written by Suzanne Smith Blancett and published by Jones & Bartlett Learning. This book was released on 1996 with total page 474 pages. Available in PDF, EPUB and Kindle. Book excerpt: Case Studies in Nursing Case Management provides portrayals of health care organizations around the nation that have successfully implemente d case management programs. It reports on how case management is being used in inpatient, ambulatory, operating room, intensive care, home h ealth, and subacute settings. Specific populations such as pediatric, maternity, dialysis, geriatric, psychiatric, and AIDS/HIV patients are also addressed. Case managers' roles in managed care and community-ba sed settings as well as in insurance companies are described.
Book Synopsis Core Skills for Hospital Case Managers by : Tony Cesta
Download or read book Core Skills for Hospital Case Managers written by Tony Cesta and published by HC Pro, Inc.. This book was released on 2009-06 with total page 319 pages. Available in PDF, EPUB and Kindle. Book excerpt: Core Skills for Hospital Case Managers: A Training Toolkit for Effective Outcomes Toni Cesta, PhD, RN, FAAN; Beverly Cunningham, MS, RN As of June 20, 2014, contact hours for nurses are no longer available with this product. Finally--an affordable, effective, and consistent training program for your hospital case managers. This one-of-a-kind guide to fundamental case management responsibilities is a necessary reference tool for every hospital case management department. This resource is designed to give case management directors and hospital leaders the tools they need to build and strengthen the basic and advanced skills their case management staff needs to succeed. Core Skills for Hospital Case Managers is an orientation and training manual for nurses transitioning into case management, an easy-to-read reference guide for new case managers, and a source of inspiration, tools, and resources for seasoned professionals. With a flexible format, this book and CD-ROM offer practical information and customizable tools to develop and maintain a wide variety of care management skills. Table of contents Chapter 1: Hospital Case Management 101 Chapter 2: Case Manager Role Chapter 3: Roles, Functions, and Caseloads Chapter 4: The Case Management Process Chapter 5: The Case Manager's Role in Transitional and Discharge Planning Chapter 6: Utilization Management Chapter 7: Managing Long Length of Stay Patients Chapter 8: Denials: Prevention and Appeals Strategies Chapter 9: Reimbursement Chapter 10: The Role of the Case Manager in Patient Flow Chapter 11: Measuring Success: Strategic Outcome Measures Chapter 12: Dealing with the Uninsured and Underinsured Chapter 13: Working with Multidisciplinary Teams Chapter 14: Crucial Communication and Conflict Resolution Learning objectives: Discuss the evolution of hospital case management Explain the different models of hospital case management Determine the various goals of hospital case management Examine the various roles of case management Discuss the variety of functions performed by case managers Discuss the scope of the case manager position Examine staffing ratios in various models List the steps in the case management process Determine the role of case managers in documentation Examine case managers' role in discharge planning List the factors that influence the discharge planning process Determine strategies for improving discharge planning Discuss how hospital reimbursement affects utilization management (UM) List the stages of UM coordination Determine the affect of outside influences on UM Evaluate different payers' regulations regarding UM Examine case management's role in length of stay (LOS) Evaluate strategies for managing patients with long LOS Identify data used to track and trend LOS Evaluate the reasons behind denials Discuss case management's role in preventing denials Examine case management's roles in reversing denials Examine case management's role in reimbursement Determine strategies for effective case management related to reimbursement Evaluate case management's role in patient flow Discuss demand and capacity management Identify strategies for managing patient flow Identify measurable case management outcomes Explain how case managers can track quality outcome metrics Discuss other metrics case management departments can track and trend Examine ways to create a case management report card Discuss the unfunded or underfunded patient populations Describe the role of the ED case manager with unfunded or underfunded patient populations Evaluate strategies for dealing with unfunded or underfunded patient populations Examine strategies for successfully working with multidisciplinary teams Describe sources of conflict with which case managers frequently come in contact Discuss strategies for reducing conflict Intended audience Staff nurses, charge nurses, staff educators, staff development specialists, directors of education, nurse managers, and nurse leaders
Book Synopsis Nurse-social Worker Collaboration in Managed Care by : Joellen Watson Hawkins
Download or read book Nurse-social Worker Collaboration in Managed Care written by Joellen Watson Hawkins and published by . This book was released on 1998 with total page 248 pages. Available in PDF, EPUB and Kindle. Book excerpt: The volume presents a model for this collaboration that clearly maps out and differentiates roles and responsibilities for effective nurse-social work case management teams. A team effort in itself, this book is authored by outstanding individuals from both professions. It also features the results of thorough interviews with nursing and social work leaders about collaboration, what works, what doesn't, and recommendations for the future.
Book Synopsis An Executive Guide to Case Management Strategies by : Marjorie A. Satinsky
Download or read book An Executive Guide to Case Management Strategies written by Marjorie A. Satinsky and published by Jossey-Bass. This book was released on 1995-02-15 with total page 149 pages. Available in PDF, EPUB and Kindle. Book excerpt: An Essential Guide to Case Management Copublished with the New England Healthcare Assembly Satinsky is able to coherently and quickly root out the salient issues regarding this rather complex field. . . . I learned from this book. I think you will, too. --Journal of Case Management This book describes how to plan, organize, develop, and improve case management programs that reach their full potential in both the clinical and financial management of care. In presenting case management as an overall patient care strategy, the author outlines a planning framework for program development and also provides practical advice on addressing obstacles as they occur. Key concepts are illustrated by a wide variety of examples from innovative case management programs across the country.
Book Synopsis The Case Manager's Handbook by : Catherine M. Mullahy
Download or read book The Case Manager's Handbook written by Catherine M. Mullahy and published by Jones & Bartlett Publishers. This book was released on 2009-06-15 with total page 896 pages. Available in PDF, EPUB and Kindle. Book excerpt: Written by renowned author, Catherine Mullahy, The Case Manager’s Handbook, Fourth Edition, is the ultimate how-to guide for case managers. This practical resource helps case managers build fundamentals, study for the CCM exam, and most importantly, advance their careers after the exam. Using real-life examples and an easy-to-read, conversant style, this reference defines “Best in Class” case management, examines the case management process, and presents practical procedural information. It is an excellent daily reference and training resource for new case managers and seasoned professionals in various setting facing the day-to-day challenges of case management. Certain to become the “go to resource” resource that previous editions have, this Fourth Edition features updated and enhanced chapters, and brand new chapters covering such timely topics as: * Obesity – The New Epidemic * Our Nation’s Multiculturalism and Challenges to Case Managers * Health Literacy and Adherence Issues * Pharmaceuticals – The Ever-Evolving World * Our Aging Population, Medical Advancements and New Case Management Considerations * Direct to Consumer Community-Based Case Management * Continuum Concepts
Book Synopsis Managed Care Organizations by : Colodia Owens
Download or read book Managed Care Organizations written by Colodia Owens and published by McGraw-Hill Companies. This book was released on 1995 with total page 198 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Managed Care by : Margaret M. Conger
Download or read book Managed Care written by Margaret M. Conger and published by SAGE Publications. This book was released on 1999-01-27 with total page 305 pages. Available in PDF, EPUB and Kindle. Book excerpt: Of all the recent changes in health care, none have more dramatically affected both patients and care providers than managed care. Not only has it altered the way we pay for health care but also it has compelled a change in the way we approach health care, focusing increasingly on preventive care to reduce costs. In Managed Care, Dr. Margaret M. Conger and her colleagues examine the impact of managed care on nursing as a profession and nurses as individual caregivers. Organized into three sections, Managed Care looks at the nature of managed care, nursing strategies in acute care hospitals, and nursing strategies in community settings. Section I examines the evolution of managed care, definitions, and issues informing this method of service delivery, and nursing involvement in quality of care and case management. In Section II, the authors look at acute care settings, discussing the use of nurse extenders, advanced practice nursing, case management, automated clinical pathways, and outcome research. Section III addresses the community settings and explores case management, advanced practice roles in community health clinics, and collaboration in primary care settings. Managed Care will serve as an excellent course text on nursing and managed care, as well as being a useful introduction and shelf reference for professional nurses at all levels.
