External Case Management
CARE Associates Network Providers believe that successfully caring for a patient begins by implementing a timely and accurate external case management process. Therefore, nurse case managers are available to assess patients in hospitals and other care settings to obtain the most up-to-date and accurate assessments. Initial comprehensive assessments allow for the appropriate level of care and sen/ices to be delivered, which minimizes the length of stay, maintains cost and promotes positive outcomes. The case manager also identifies a viable discharge plan, which considers the patient’s medical condition, support systems and economic resources. The case manager is the initial contact person for managed care organizations and acts as the liaison between the provider and payer.
Internal Case Management
Case management is an extensive and continuous process that focuses on the achievement of patient goals within a specifically defined time frame, which is accomplished through the efforts of an interdisciplinary team. The process is coordinated by one professional, either a nurse or a social worker. Effective case management requires assessments, treatment plans and implementation, evaluations and education. These components are the framework of successfully utilizing
appropriate services and minimizing the length of stay. Assessment results, the plan of care and progress of the patient are communicated to the payer case manager by the internal manager.
CARE Associates Network Providers assist and encourage managed care organizations’ case managers to have an active role in the management of their patients by inviting them to participate in care planning meetings, either in person or through telephone conferencing. Assessments and progress notes are sent via fax or electronically to case managers as per their request. The collaboration between providers and managed care organizations facilitates the most effective utilization of services and level of care for the patient.
Discharge Planning Process
The plan for discharge is developed upon admission of the patient and is executed when reasonable treatment goals have been achieved. Discharge planning is a systematic and interdisciplinary process coordinated by a social worker and/or a nurse. The goals for discharge are to ensure that the patient is transitioned to the appropriate level of care, that the patient and/or caregivers have been adequately trained in necessary skills and to arrange for continued rehabilitation and/or medical services as needed.