Definition And Philosophy Of Case Management Case Study

Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client's health and human service needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes. A Case Manager is a person (as a social worker or nurse) who assists in the planning, coordination, monitoring, evaluation of medical services for a patient with emphasis on quality of care, continuity of services, and cost-effectiveness. ("Definition and Philosophy of Case Management", 2015).
For the past 18 years Gloria Bagnerise has been a dedicated registered nurse with five years of experience currently

as a RN Case Manager /Cardio-Pulmonary Vent Telemetry Stepdown Unit at Kaiser Permanente. Kaiser Permanente’s new state-of-the-art Fontana Medical Center Hospital provides affordable, high-quality health care to members in the central Inland Empire service area. The size is nearly 490,000 square feet, hospital capacity is 314 beds, and emergency department has 51 beds. The Fontana Medical Center has added 50-100 new employees. The central utility plant is 22,775 square feet and the center was newly remodeled in May 2013. The Fontana Medical Center provides primary care, obstetrics, gynecology, and pediatric healthcare services. They also provide specialty services such as cardiac catheterization laboratory, cardiac surgery services, an inpatient dialysis unit, an intensive care unit, labor and delivery, neonatal intensive care unit, pediatric intensive care unit, and pediatric surgery.
Gloria obtained her Bachelor’s degree in Nursing Science and a Master’s degree in Nursing Science.

Gloria possesses a strong background in hospice triage and as a vocational nurse clinical/skill instructor. Gloria has experience delivering CPR training programs to staff and students. In addition, Gloria has a strong background in computer skills, managing heavy daily patient volume, appointments, scheduling, and patient referrals. She contributes her success in her occupation to the education she has received, but mostly from her experiences working as a registered nurse. A typical day of a case manager includes developing and modifying plans of care, conducting and attending team meetings, completing home and vocational visits, computer input and documentation, client referrals, scheduling meetings. No two days are ever the

same.
A good case manager is someone who is capable of prioritizing, can adapt to change, is able to meet timelines, likes to work with a diversified group of people, understands fiscal responsibility, is willing to research to find the best possible solutions to serve the individuals on their caseloads and their unique problems, is willing to learn and to teach what they have learned to others, is compassionate and at the same time capable of separating themselves to prevent making their caseload their life, knows how to set realistic goals for themselves and the individuals on their caseload, can stay calm in volatile situations, can work well with others to achieve common goals, is a good advocate, likes the combination of field and office work. The best part of the job is reaching out to the members, helping them complete their care plans and preventing return visits to the hospital. First Gloria checks her work queue for the day, review the hospital census, if she has members who are in her department, she reviews the hospital summary, places a call to the member, and once they are discharged she call them to review their discharge instructions. She is responsible for making sure members in telemetry case management get certain tests done, follow up with a specialist, and make sure they have the required vaccinations. Gloria also assists the members with making sure they are taking their medications, and assists with transportation. Through patient education she teaches them about their disease process, signs and symptoms to report which is done over the phone. Gloria provides case management for members who are more at-risk for hospitalization or serious, permanent or long-term effects from their disease. She interacts regularly with the telephonic case managers, disease managers and social workers, coordinate care for members, and manage members with complex and multiple needs to ensure they receive appropriate healthcare. Gloria is responsible for the overall plan of patient care for a specific patient population. Gloria coordinates appropriate resources to facilitate and ensure the member's progress through the continuum of care from pre-hospital admission to post-hospital care. She is responsible for assessment, planning, coordination, implementation, evaluation and completion of the care plan.
Progressive care/telemetry nurses work in hospital units that go by various names, such as telemetry units, intermediate care units, direct observation units, step-down units, or transitional care units. These units provide critical care to patients who require constant monitoring for a range of reasons, including recent surgery, heart attacks, congestive heart failure, renal failure, COPD, and advanced cancer. ("How To Become A Telemetry Nurse", 2015).
The implementation of the Patient Protection and Affordable Care Act (PPACA) has expanded the role of the case manager.

Auslander and Carneal, JD, MA (2014) Important issues facing case managers today are transition of care, accountable care organizations, expanded health insurance coverage, and implementation challenges to name a few. PPACA has important goals of easing patient transitions and decreasing readmission. Case managers are impacted by this because they are charged with the education and support of patients through coordinating effective care as the patient moves through the healthcare continuum. Implementing the changes mandated by PPACA can be difficult. Patients experienced problems with the public enrollment efforts which created some distrust of the PPACA and new programs. Expanded health coverage has resulted in an additional 25 million Americans with healthcare coverage. (Auslander & Carneal, JD, MA, 2014) it will require a case managers to educate and manage these patients on a much larger scale, while there is a shortage of nurses in the healthcare industry. Continuity of care then becomes a concern for the case manager. Case managers are now an integral part of the solution as Congress and others address specific healthcare reform

opportunities.