Case management refers to the processes of facilitation, assessment, planning, evaluation, and care coordination in meeting family and individual health needs. The premise of case management is on individuals reaching their optimum levels of functional and wellness capabilities. Phaneuf (2008) notes that the concept of case management aims at providing quality care to patients as well as providing continuity of health care services most effectively and efficiently in a social context. This paper reviews the critical roles and responsibilities bestowed on a case manager.
The foremost responsibility of a case manager is the coordination of case management services. The case manager performs the role of a catalyst to the case management team in a health institution. The health care team comprises of health care providers with diverse cultures and professionalism. It is upon the case manager to consolidate their specialization to the core mandate of the health center, and essentially, align their services to the concept of case management. Essential in the coordination role of a case manager is establishing a clear and effective communication channel. The members of the institution would be required to follow the channels of communication for a well-coordinated delivery of information in the institution. In an episode where there are interactions with various members in case management, the coordination role is critical. The coordination would involve the outpatient services, rehabilitation, community services, and the case manager.
The three critical components of coordination in case management are clinical responsibilities, managerial responsibilities, and the coordination and organization of the multidisciplinary group. In coordination also, the case manager socially receives the patient as a way of developing a social partnership with him or her, gathering critical information about him and assessing the levels of illness. This is important for prompt and proper communication of the patient’s case to the relevant personnel in the health care institution.
In the case of management, the primary role is coordination of services by facilitation, assessment, care coordination, evaluation, and planning of comprehensive healthcare. The aim is to promote cost-effective and quality care to the patients. In this role, therefore, the utmost role of a case manager is the administration of important elements of healthcare for the quality provision of services to patients. Challis (April 2010) explains this and notes that the case managers are charged with the day-to-day management of healthcare institutions and care homes. Administrating is critical as it enhances smooth operations and communications of essential information to the caregivers and the patients at home and health facilities. In administration, the case manager has to be a proficient communicator. This is essential in giving proper information for effective case management.
Provision of Primary Care
Case management operates in the realms of a wider program of health care in multiple strategies (Hutt, 2014). A critical focus is on ensuring that patients coming to healthcare facilities access primary care and primary prevention. This important role of a case manager makes him or her come into contact with the critical illnesses of incoming patients. He or she becomes the first person to handle the first care to the patient. Most of the primary care services that have been handled by case managers are community-based. The case managers coordinate primary care in the fields where primary care services and primary prevention are needed.
There are several targeted results in primary care given by the case managers. First, primary care helps in improving the outcomes of the health care to the patients. It is also important in the reduction of hospital utilization as well as enhancing the experience of the patients. As a primary caregiver, the case manager has to design a comprehensive action plan that is social and friendly to the patient. The action plan has to be based on best practices. Essentially, the case managers are recognized as central in the provision of home services and provision of patient education in homes as a way of disease management.
A case manager is the spokesperson of the health facility and care home in the provision of healthcare. A spokesperson serves as the liaison officer between the patients and management. He or she is the link between the healthcare facilities and the patients in need of hospital services or care home provision. Murray (March 2010) writes about this and notes that case management has to have a dominant structure that reimburses and delivers health care. Case management has to assist and shape health care systems, and therefore, a care manager has to communicate critical issues to relevant personnel and the patients.
In the case of management, managers focus on promoting the living of patients by giving them self-care and hospital care. In performing this, the case manager has to be a good evaluator of pertinent issues and a communicator of information to relevant professional medical officers. For example, in-home care, when primary care is not sufficient, the case manager has to be in touch with the relevant specialist. This art of communication has to exercise at all times, especially in emergencies. Critical communication skills include analysis, prompt response, and prompt synthesis of information available in healthcare.
Challis, D. (2010). “Self-Care and Case Management in Long Term Conditions: The Effective Management of Critical Interfaces.” Report for the National Institute for Health Research Service Delivery and Organization Program, 1(2), 1-258.
Hutt, R. (2014). “Case-Managing Long Term Conditions: What Impacts Does it Have?” The King’s Fund Journal, 1(1), 1-28.
Murray, L. (2010). “Case Management Practice Guide: 7 Phases of Case Management.” Journal of Human Services, 2(1), 1-28.
Phaneuf, M. (2008). “The Roles and Qualities Required of a Case Manager: Case Management – Part 3.” Journal of Healthcare Management, 1(1), 1-7.