Exam #1: Case Management
What is a case manager accountable for? -
The case manager is accountable for collaboratively facilitating the assessment, planning,
implementation and evaluation of care coordination and care transitions in the acute care setting.
What are case managers advocates for? -
Nurse case managers serve as advocates for options and services to meet the patient and family
needs, while promoting quality, cost effective outcomes for the assigned case types.
What are 5 key functions and responsibilities of a case manager? -
1. Coordination and facilitation of care
2. Utilization and resource management
3. Tracking of avoidable delays
4. Transitional and discharge planning
5. Quality and process improvement
A nurse case manager must encompass a knowledge of the health care environment with regards to
what 4 aspects? -
1. Clinical
2. Business/Financial
3. Managerial
4. Professionalism
In the clinical setting, what type of assessment does the case manager perform? -
Patient and family interview and review of medical record
What type of planning is performed by the case manager in a clinical setting? -
Consult with the physician, health care team and patient/family - develop plan of care to facilitate a
timely discharge /transition plan
What type of implementation is performed by the case manager in the clinical setting? -
Implements the plan of care in a timely manner to facilitate accomplishment of goals and
interventions.
What type of evaluations do case managers perform in the clinical setting? -
Reassessment for any decline in status and plan revisions
What are 4 roles of the case manager in managing business/financial concerns? -
1. Ensure that the level of care is appropriate and services are medically necessary
2. Proactively identify delays in care, delays in discharge and risk of readmission
3. Maintain competence of utilization review (inpatient vs. observation status)
4. Document avoidable delays/days
What are 5 managerial duties of the case manager? -
1. A nurse case manager must display leadership skills in decision making and problem solving
, 2. Must actively participate in Interdisciplinary Team Meetings and maintain open communication with
physicians
3. Strive to make productive use of time through the setting of priorities
4. Foster an environment of professionalism
5. Utilize the Chain of Command effectively in addressing complex/unusual situations
What are 5 key points that the case manager is responsible for in instituting professionalism in the
profession? -
1. Integrate high ethical standards and core values
2. Hold self and others accountable
3. Perform work in an accurate and timely manner
4. Serve as a role model and mentor
5. Maintain current clinical knowledge and leadership skills
What is a clinical pathway? -
A clinical pathway is a map of clinical practice for a particular diagnosis - also known as care maps.
It is a timeline for patient care activities which is used by all disciplines
What are clinical pathways used to achieve? -
Clinical pathways have emerged as a popular method to standardize care while reducing costs and
improving quality of care
What term has Cone Health renamed their clinical pathways and why? -
Cone Health has renamed them to "Patient Care Plan" in an attempt to make them more
individualized
What are 3 advantages of clinical pathways? -
1. Enhances interdisciplinary collaboration
2. Helps to reduce unnecessary variations in patient care and outcomes, improving quality
3. A tool to incorporate local and national guidelines into everyday practices
How are clinical pathways used? (3) -
1. Permanent part of medical record
2. Used in lieu of Care Plan and Orders
3. The nurse in charge and the attending physician will select the appropriate on admission
How are clinical pathways used in the case management process? (2) -
1. Clinical pathways help case managers appropriately manage a patient's care related to the
admitting diagnosis
2. CP help to improve quality, decrease cost, manage length of stay and avoid delays in care
In what settings are we now finding case management now that it has moved past the acute care
setting? (5) -
1. Home health agencies
2. Physician practices
3. Medical respite programs
4. Faith based programs
5. Independent case management consulting firms
What is a case manager accountable for? -
The case manager is accountable for collaboratively facilitating the assessment, planning,
implementation and evaluation of care coordination and care transitions in the acute care setting.
What are case managers advocates for? -
Nurse case managers serve as advocates for options and services to meet the patient and family
needs, while promoting quality, cost effective outcomes for the assigned case types.
What are 5 key functions and responsibilities of a case manager? -
1. Coordination and facilitation of care
2. Utilization and resource management
3. Tracking of avoidable delays
4. Transitional and discharge planning
5. Quality and process improvement
A nurse case manager must encompass a knowledge of the health care environment with regards to
what 4 aspects? -
1. Clinical
2. Business/Financial
3. Managerial
4. Professionalism
In the clinical setting, what type of assessment does the case manager perform? -
Patient and family interview and review of medical record
What type of planning is performed by the case manager in a clinical setting? -
Consult with the physician, health care team and patient/family - develop plan of care to facilitate a
timely discharge /transition plan
What type of implementation is performed by the case manager in the clinical setting? -
Implements the plan of care in a timely manner to facilitate accomplishment of goals and
interventions.
What type of evaluations do case managers perform in the clinical setting? -
Reassessment for any decline in status and plan revisions
What are 4 roles of the case manager in managing business/financial concerns? -
1. Ensure that the level of care is appropriate and services are medically necessary
2. Proactively identify delays in care, delays in discharge and risk of readmission
3. Maintain competence of utilization review (inpatient vs. observation status)
4. Document avoidable delays/days
What are 5 managerial duties of the case manager? -
1. A nurse case manager must display leadership skills in decision making and problem solving
, 2. Must actively participate in Interdisciplinary Team Meetings and maintain open communication with
physicians
3. Strive to make productive use of time through the setting of priorities
4. Foster an environment of professionalism
5. Utilize the Chain of Command effectively in addressing complex/unusual situations
What are 5 key points that the case manager is responsible for in instituting professionalism in the
profession? -
1. Integrate high ethical standards and core values
2. Hold self and others accountable
3. Perform work in an accurate and timely manner
4. Serve as a role model and mentor
5. Maintain current clinical knowledge and leadership skills
What is a clinical pathway? -
A clinical pathway is a map of clinical practice for a particular diagnosis - also known as care maps.
It is a timeline for patient care activities which is used by all disciplines
What are clinical pathways used to achieve? -
Clinical pathways have emerged as a popular method to standardize care while reducing costs and
improving quality of care
What term has Cone Health renamed their clinical pathways and why? -
Cone Health has renamed them to "Patient Care Plan" in an attempt to make them more
individualized
What are 3 advantages of clinical pathways? -
1. Enhances interdisciplinary collaboration
2. Helps to reduce unnecessary variations in patient care and outcomes, improving quality
3. A tool to incorporate local and national guidelines into everyday practices
How are clinical pathways used? (3) -
1. Permanent part of medical record
2. Used in lieu of Care Plan and Orders
3. The nurse in charge and the attending physician will select the appropriate on admission
How are clinical pathways used in the case management process? (2) -
1. Clinical pathways help case managers appropriately manage a patient's care related to the
admitting diagnosis
2. CP help to improve quality, decrease cost, manage length of stay and avoid delays in care
In what settings are we now finding case management now that it has moved past the acute care
setting? (5) -
1. Home health agencies
2. Physician practices
3. Medical respite programs
4. Faith based programs
5. Independent case management consulting firms
