CMSA Core Curriculum for Case Management.

Cover -- Half Title -- Series Title -- Title -- Copyright -- Dedication -- Contributors -- Reviewers -- Foreword -- Preface -- Acknowledgments -- Contents -- SECTION 1 The Foundation of Case Management Practice -- CHAPTER 1 Introduction to the CMSA Core Curriculum for Case Management -- Introduction -- Descriptions of Key Terms -- Applicability of the Core Curriculum to CMSA's Standards of Practice for Case Management -- Historical Perspective on CMSA's Standards of Practice for Case Management -- Select Definitions of Case Management -- Philosophy of Case Management -- Guiding Principles of Case Management -- The Case Management Team -- CHAPTER 2 History and Evolution of Case Management -- Introduction -- Descriptions of Key Terms -- Applicability to CMSA'S Standards of Practice -- Factors for the Rapid Growth of Case Management -- Professional Development of Case Management Practice -- Purposes and Goals of Case Management -- Philosophical Tenets of Case Management -- Case Management Knowledge Domains -- Case Management Target Populations -- Case Management Versus Other Job Titles -- CHAPTER 3 Health Care Insurance, Benefits, and Reimbursement Systems -- Introduction -- Descriptions of Key Terms -- Applicability to CMSA's Standards of Practice -- Driving Forces Behind Health Care Reimbursement Systems -- Types of Insurance -- Components of Health Care Reimbursement -- Health Care Delivery Systems -- Reimbursement Methods -- Challenges with Health Care Reimbursement -- Legal Issues Impacting Managed Care -- Strategies in Managed Care -- Compliance Considerations for Case Managers -- Reimbursement Implications for Case Managers -- CHAPTER 4 Case Management Practice Settings -- Introduction -- Descriptions of Key Terms -- Applicability to CMSA's Standards of Practice -- Case Management Practice Settings -- Telephonic Case Management.

Case Management in the Payer-Based Settings or Insurance Companies -- Case Management in the Community Care Setting -- Case Management in the Ambulatory Clinic and Outpatient Care Setting -- Case Management in the Patient-Centered Medical Home Care Setting -- Case Management in the Admitting Department -- Case Management in the Perioperative Services -- Independent/Private Case Management -- Case Management in the Emergency Department -- Patient Flow, Throughput, and Case Management -- Transitions of Care and Case Management -- Role of the Case Manager in Patient Safety and Prevention of Medical Errors During Transitions -- SECTION 2 Case Management and the Health Care Continuum -- CHAPTER 5 Case Management in the Acute Care Setting -- Introduction -- Descriptions of Key Terms -- Applicability to CMSA's Standards of Practice -- Background/Historical Perspective -- Distinguishing the Hospital Venue -- Physician Partnerships -- Designing a Case Management Model for Your Hospital -- Case Management Program Infrastructure -- Workflow -- Program Operations -- Outcomes -- CHAPTER 6 Case Management in the Community and Postacute Care Settings -- Introduction -- Descriptions of Key Terms -- Applicability to CMSA's Standards of Practice -- Federally Qualified Health Centers -- Patient-Centered Medical Home -- Accountable Care Organizations -- Roles of Case Managers in FQHCs, PCMHs, and ACOs -- Long-Term Care -- Rehabilitation Levels of Care -- Rehabilitation Services in Non-Inpatient Care Settings -- Nonmedical Levels of Care -- Respite Care -- Financial Aspects of Long-Term and Rehabilitation Care Settings -- Case Management Roles in Long-Term and Acute Rehabilitation Care Settings -- Resources for the Care of the Elderly -- The Geriatric and Older Adult Patient -- Identification of High-Risk Geriatric Patients -- Comprehensive Geriatric Assessment.

Geriatric Assessment for Placement of the Geriatric Patient -- CHAPTER 7 Case Management in the Home Care Setting -- Introduction -- Descriptions of Key Terms -- Applicability to CMSA's Standards of Practice -- The Role of the Hospital-Based Interdisciplinary Health Care Team -- Home Health Care Visits -- Reimbursement for Home Health Care Services -- Home Care Nursing Services -- Home Care Rehabilitation Services -- Durable Medical Equipment and Other Services -- Home Care Social Work Services -- The Role of the Hospital-Based Case Manager -- The Role of the Community-Based Case Manager -- Savings, Safety, and Satisfaction -- CHAPTER 8 Case Management in the Palliative and Hospice Care Settings -- Introduction -- Descriptions of Key Terms -- Applicability to CMSA's Standards of Practice -- Palliative Care -- Hospice Care -- Guiding Principles and Goals of Palliative and Hospice Care Programs -- Scope of Palliative and Hospice Care and Services -- Advance Directives and Health Care Proxies -- Case Management Services in Palliative and Hospice Care Programs -- CHAPTER 9 Case Management in the Remote and Rural Care Settings -- Introduction -- Descriptions of Key Terms -- Applicability to CMSA's Standards of Practice -- Understanding Designation of Areas Within United States -- Rural Culture Health Care Considerations -- Rural Case Management Programs and Services -- Behavioral Health Care in Rural Areas -- The Patient Protection and Affordable Care Act and Rural Case Management -- CHAPTER 10 Transitional Care and Case Management -- Introduction -- Applicability to CMSA's Standards of Practice -- Descriptions of Key Terms -- NTOCC Care Transitions Bundle: Seven Essential Intervention Categories -- Legislative and Regulatory Considerations Pertaining to Transitions of Care -- Transition of Care Models and Delivery Systems.

Transitions of Care and Implications for Case Management Practice -- Roles and Functions Associated with Transitions of Care -- Reimbursement Issues -- Certification and Accreditation in Transitions of Care -- SECTION 3 Roles, Functions, and Essential Practice Considerations for Case Managers -- CHAPTER 11 The Roles, Functions, and Activities of Case Management -- Introduction -- Descriptions of Key Terms -- Applicability to CMSA'S Standards of Practice -- Background -- Case Management Roles -- Case Management Functions and Activities -- Case Management Knowledge for Practice and Qualifications -- Case Management Knowledge and Skills According to the American Nurses Credentialing Center -- Conclusion -- CHAPTER 12 The Case Management Process -- Introduction -- Descriptions of Key Terms -- Applicability to CMSA's Standards of Practice -- Steps of the Case Management Process -- Special Actions Occurring Throughout the Case Management Process -- CHAPTER 13 Transitional Planning and Transitions of Care -- Introduction -- Descriptions of Key Terms -- Applicability to CMSA's Standards of Practice -- Transitional Planning as it Relates to Continuity of Care -- Federal Conditions of Participation that Influence Transitional Care From Acute Care Hospitals -- Other Selected Federal Rules that have Significance in Transition Planning -- Factors that Impact Case Management in Cross-Setting Measures -- Selected Levels of Care to Which Inpatients are Referred -- The Role of the Case Manager in the Process of Transitional Planning -- Value-Based Purchasing and Impact on Transition Management and Readmissions -- Case Manager and Managing Care Transitions -- CHAPTER 14 Resource and Utilization Management -- Introduction -- Descriptions of Key Terms -- Applicability to CMSA'S Standards of Practice -- UM Program and Process -- UM Team.

Certifications Related to UM and UR -- UM Criteria and Strategies -- UM Clinical Review Criteria and Guidelines -- Focused UM -- Denials of Admissions and Services -- Adverse Review Determination -- Medical Review Outcomes -- Appeal Process -- UM Performance Reporting -- Key Regulatory and Accreditation Bodies Associated with the UM Process -- UM Regulatory and Accreditation Processes -- Certification Programs in UR or UM -- CHAPTER 15 Case Management and Use of Technology -- Introduction -- Descriptions of Key Terms -- Applicability to CMSA'S Standards of Practice -- Health Information Technology and Case Management Information Systems -- Goals, Benefits, and Limitations of Case Management Information System (CMIS) -- CMIS and Case Management Informatics in Support of Consistency and Standards of Care -- Using CMIS to Measure Effectiveness of Case Management Intervention -- The Evolution and Delivery of Telehealth Interventions -- Telehealth Legislation -- Barriers to Telehealth -- Evaluation of Web Sites for Professional and Patient Use -- HIT Solutions in Support of Case Management -- CHAPTER 16 Case Manager's Role Leadership and Accountability -- Introduction -- Descriptions of Key Terms -- Applicability to CMSA's Standards of Practice -- Accountability -- Leadership Styles -- Leadership Skills -- Negotiation Skills -- Delegation Skills -- Communication Skills for Quality and Patient Safety -- Critical Thinking and Decision-Making -- The Ethics of Decision-Making -- Financial/Cost-Benefit Analysis -- Case Management Outcomes in the Supervisory Role -- Case Managers as Change Agents -- Case Managers and Motivational Interviewing -- CHAPTER 17 Professional Development, Certification, and Accreditation in Case Management -- Introduction -- Descriptions of Key Terms -- Applicability to CMSA's Standards of Practice.

Education and Training of Case Managers.

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Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, 2024. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries.