Case Management and Nursing This paper looks at what constitutes ca

Case management in nursing is a process of coordinating health care interventions across levels of care to achieve measurable cost and quality outcomes (Zander, 2002). The Case Management Society of America defines case management as, ôa collaborative process which assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individualÆs health needs through communication and available resources to promote quality cost-effective outcomesö (Kuntz, 1999). Case management is performed by nurses in a variety of settings and produces a balance between the demands of quality health care and the patient and/or organizationÆs costs and resources (Zander, 2002).

Case management was developed in the early 1900s by social workers and public health nurses who identified needs and procured resources for their patients (Zander, 2002, 59). Payers began to use case management by nurses in the 1960s to oversee medical necessities for critically ill patients. This role was eventually provided by acute care hospitals, calling it ôutilization review,ö as a way to deal with payers. Case management under

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ealth care system of today if they had not evolved just at the time of a critical nursing shortage (61). Because of the shortage, many case managers are fulfilling the roles of staff nurses, and because of current economics, many hospitals have been cutting back on staff, and their plans to employ case managers. In hospitals, case managers often have the merged roles of utilization review and discharge planning, while in the insurance industry, they confirm medical necessity and recommend authorization of needed services (Kuntz, 1999). Case managers also operate independently, and can provide a full scope of services across a variety of settings (169). As a discipline, case management requires specialized skills and knowledge of how various medical, insurance, government, and corporate processes affect healthcare delivery. Case managers must be aware of the types of settings in which care is delivered and what care is available, and be able to match these to the needs of patients. They must keep current with changes in federal and state legislation and how they impact healthcare delivery and the options available to patients. Case management provides the ideal situation for a renal dialysis unit (White, 1996). One mode
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Approximate Word count = 1271
Approximate Pages = 5 (250 words per page)

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