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What Is Case Management?

Case management services are generally provided by people who have experience in the healthcare field.
Healthcare case management tools can help a doctor reduce the time he spends on administrative tasks.
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  • Written By: Lainie Petersen
  • Edited By: Melissa Wiley
  • Last Modified Date: 03 December 2014
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Case management is an approach to coordinating care for individuals in the health, mental health, or social welfare systems. The term can be used to describe the coordination of care and services within the insurance industry, but can also describe an approach to connecting medical and mental health patients with community and health care resources. The goal of case management is to ensure that individuals who need care receive it and that insurance, medical, and social resources are used efficiently.

Many individuals who have a need for health care services, particularly mental health care services, require assistance that goes beyond the scope of what medical and mental health care systems can offer. It is often crucial to the well-being of a patient, however, to ensure that he has a place to live, food to eat, and appropriate care at home. Without these supports, the efficacy of health care can be undermined, sometimes to the point where it is ineffective. Case management provides vulnerable patients with a point person who can connect the patient with community resources and family in hopes of better understanding his situation and needs. Depending on the patient's situation, either the health care setting or an outside agency may provide a patient's primary case management services.

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Case management services are provided by individuals who typically have training either in the medical or social work fields. Many medical case managers are nurses, though some are social workers. In social service agencies, case managers may also be social workers, though some may not hold any particular mental health credentials. In some countries, such as the United States, it is possible for a case manager to acquire certification through a professional society for case managers.

In the health insurance and managed care industries, a case manager can work with individuals who have serious health problems to make sure they are getting appropriate, cost-effective care. The case manager can work with service providers to settle appropriate rates and payments for services, refer the client to specialists, and help the client make decisions about her care. Some health insurance companies routinely appoint case managers to policy holders with serious or chronic conditions. Employers may also use the services of case managers who can help the organization work with employees who have long-term medical needs and who can support employees in caring for themselves as well as insuring that the organization can make proper accommodations for the employee's needs.

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sweetPeas
Post 4

My mother is in her 90s and was recently in the hospital with complications with her congestive heart disease.

After about a week, she was ready to leave the hospital. My siblings and I were very pleased with the care she got from the social worker who was assigned to her case.

The case manager did a great job of documenting what services she would need in the next few weeks, arranging for care in a rehab center, with therapy and goals.

She then followed up with a program of therapists and visiting nurses to monitor her progress after she returned home. The whole thing was very well organized and monitored. We didn't have to do much except be aware of what steps were being taken.

Bertie68
Post 3

Many trained social workers take on jobs as case managers. Unfortunately, especially if they work for a government agency, the pay can be quite low. These social case workers are dedicated and want to help people.

Often their case loads are high and it is hard to keep on top of things. My neighbor is a social worker and she comes home exhausted and frustrated after some of her difficult days. But she wouldn't think of doing anything else.

She works in case management for children, families and the elderly trying to help them get the services they need. The bureaucracy and all the delays can be very frustrating.

Nevertheless, for her, the chance to help others is far more satisfying than sitting at a computer all day.

Azuza
Post 2

@ceilingcat - I have a friend who works in the field of social work, and she told me it can be very draining. She loves her job though!

I've never personally dealt with a social work case manager, but I have dealt with a medical case manager before. One of my older relatives was very ill, and the case manager helped organize his care. She let us know what benefits he was eligible for under Medicare and also helped us find him some good in home care.

The case manager was really helpful to us, because none of us were medical professionals. It's helpful to have someone who knows the system guide you and let you know what your options are.

ceilingcat
Post 1

A friend of mine is a social worker, and she does case management. I think having a case manager makes a lot of sense, because I can see how it would be easy to let things slip through the cracks.

For example, if someone is getting a few different types of social assistance, you need to make sure that they don't overlap. But then you also need to make sure they are getting enough assistance. From what my friend tells me, it sounds like you need a lot of organizational skills to do this job effectively.

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