for what type of care should the physician practice manager expect to work with a case manager

The case management cognition framework consists of what case managers need to know (knowledge, skills, and competencies) to finer treat clients and their support systems. It includes two main elements:

1. A nine-phase Case Management Procedure
2. Vi essential cognition domains (previously seven domains that have been updated based on findings of the case director'due south office and role study CCMC recently conducted)

These elements are applicative in any care or practice setting and for the diverse healthcare professionals who assume the instance manager's role and/or those directly or indirectly involved in the field.

Definition of Instance Management

At that place is no one standardized or nationally recognized or fifty-fifty widely accustomed definition of case management. An Internet search for the definition of the term instance direction will upshot in thousands of references. Such results are confusing for case managers and others who are interested in example management practice. You may be unable to discern which definition is most credible or relevant.

Despite the big search consequence, experts would agree that in that location are no more than than 20 or so definitions of case management considered appropriate. These definitions are bachelor in peer-reviewed professional person case management literature or on Web sites and in other formal documents of case management (or case management-related) organizations, societies, and government or nongovernment agencies.

The Example Direction Knowledge Framework

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And so that you do not become dislocated as y'all read materials in the Commission for Case Manager Certification'due south (CCMC) CMBOK®, the skillful contributors who developed the instance direction cognition framework in 2009 decided to employ the Commission'due south definition of case management available at that time to guide their work. (Note that the definition below has since been updated to reflect current appropriate information promulgated by CCMC.)

"Case management is a professional and collaborative procedure that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual's health needs. Information technology uses communication and available resources to promote wellness, quality, and cost-effective outcomes in support of the 'Triple Aim,' of improving the experience of care, improving the health of populations, and reducing per capita costs of health care." (CCMC, 2015, p. iv)

Example Management Philosophy and Guiding Principles

Example management is a specialty practice within the health and human services profession. Everyone direct or indirectly involved in healthcare benefits when healthcare professionals and especially case managers appropriately manage, efficiently provide, and effectively execute a customer's care. The underlying guiding principles of case management services and practices of the CMBOK follow:

• Case management is not a profession unto itself. Rather, information technology is a cross-disciplinary and interdependent specialty exercise.
• Case management is a ways for improving clients' health and promoting wellness and autonomy through advocacy, communication, teaching, identification of service resource, and facilitation of service.
• Case management is guided by the ethical principles of autonomy, beneficence, nonmaleficence, veracity, equity, and justice.
• Case managers come from different backgrounds inside health and human services professions, including nursing, medicine, social work, rehabilitation counseling, workers' bounty, and mental and behavioral health.
• The primary function of case managers is to advocate for clients/support systems. Example managers understand the importance of achieving quality outcomes for their clients and commit to the advisable use of resources and empowerment of clients in a mode that is supportive and objective.
• Case managers' first duty is to their clients – analogous care that is safe, timely, constructive, efficient, equitable, and customer-centered.
• Case management services are offered co-ordinate to the clients' benefits as stipulated in their wellness insurance plans, where applicable.
• The Case Management Process is centered on clients/support systems. Information technology is holistic in its handling of clients' situations (eastward.k., addressing medical, physical, functional, emotional, financial, psychosocial, behavioral, spiritual, and other needs), as well as those of their back up systems.
• The Case Management Process is adaptive to case managers' practice settings and the settings where clients receive health and human services.
• Example managers arroyo the provision of case-managed health and human services in a collaborative manner. Professionals from within or across healthcare organizations (e.thou., provider, employer, payor, and community agencies) and settings interact closely for the benefit of clients/support systems.
• The goals of case direction are starting time and foremost focused on improving the client'southward clinical, functional, emotional, and psychosocial status.
• The healthcare organizations for which case managers piece of work may also do good from case management services. They may realize lowered health claim costs (if payor-based), shorter lengths of stay (if acute care-based), or early return to work and reduced absence (if employer-based).
• All stakeholders benefit when clients reach their optimum level of wellness, self-care management, and functional capability. These stakeholders include the clients themselves, their support systems, and the healthcare delivery systems, including the providers of care, the employers, and the diverse payor sources.
• Case management helps clients achieve wellness and autonomy through advocacy, comprehensive assessment, planning, communication, wellness education and engagement, resource management, service facilitation, and utilize of evidence-based guidelines or standards.
• Based on the cultural behavior, values, and needs of clients/back up systems, and in collaboration with all service providers (both healthcare professionals and paraprofessionals), case managers link clients/back up systems with appropriate providers of care and resources throughout the continuum of health and homo services and across diverse care settings. They do so while ensuring that the care provided is prophylactic, effective, client-centered, timely, efficient, and equitable. This approach achieves optimum value and desirable outcomes for all stakeholders.
• Example direction services are optimized when offered in a climate that allows direct, open up, and honest communication and collaboration amongst the case director, the customer/support system, the payor, the main care provider (PCP), the specialty care provider (SCP), and all other service delivery professionals and paraprofessionals.
• Instance managers raise the case direction services and their associated outcomes by maintaining clients' privacy, confidentiality, health, and condom through advocacy and adherence to ethical, legal, accreditation, certification, and regulatory standards and guidelines, as appropriate to the practise setting.
• Case managers must possess the education, skills, knowledge, competencies, and experiences needed to effectively render appropriate, safe, and quality services to their clients/support systems.
• Example managers must demonstrate a sense of commitment and obligation to maintain electric current knowledge, skills, and competencies. They too must disseminate their exercise innovations and findings from enquiry activities to the instance management community for the benefit of advancing the field of example direction.

Principal Terms

Many terms in the CMBOK have multiple meanings, and yous may be unclear nigh which meaning to employ. Yous might too not interpret the terms in the way the knowledge developers – who are case management experts – idea of them.

To get the most out of the cognition these experts have shared in the CMBOK, take the time to review the following terms. Note that the literature may describe these terms somewhat differently; the descriptions shared herein clarify their use throughout the CMBOK.

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Principal Terms Used in the CMBOK

Term	Clarification
client	The recipient of example management every bit well equally health and man services. "This private can be a patient, beneficiary, injured worker, claimant, enrollee, member, college educatee, resident, or health intendance consumer of any age grouping. In addition, [use of] the term client may also infer the inclusion of the client's back up [organisation]" (CMSA, 2016, p. 33). Annotation: In the CMBOK, the term client is sometimes intended to include the customer's back up system.
client'due south support system	The person or persons identified by each individual customer to be directly or indirectly involved in the client's care. Information technology "may include biological relatives [family unit members], a spouse, a partner, friends, neighbors, colleagues, a wellness care proxy, or whatever individual who supports the client [caregivers, volunteers, and clergy or spiritual advisors]" (CMSA, 2016, p. 33).
caregiver	The person responsible for caring for a client in the home setting and can be a family member, friend, volunteer, or an assigned healthcare professional person.
case manager	The health and man services professional responsible for coordinating the overall care delivered to an private client or a grouping of clients, based on the client's health or human services problems, needs, and interests.
case management plan	(Also referred to equally case management department.) An organized approach to the provision of example management services to clients and their support systems. The program is usually described in terms of: Vision, mission, purpose, goals, strategic objectives, and target outcomes Number and type of staff, including roles, responsibilities, and expectations of each A specific model or conceptual framework that delineates the central case management functions within the program or department Reporting construction inside the system How the program or section connect with or chronicle to other programs or departments within the healthcare organization The process and metrics applied in the evaluation or the programme or department and its contribution to the healthcare organization, especially its bottom line
Case Direction Process	The process through which case managers provide health and homo services to clients/support systems. The procedure consists of several phases that are iterative, cyclical, and recursive rather than linear and that are applied until clients' needs and interests are met. The phases of the process are: Screening Assessing Stratifying Hazard Planning Implementing (Care Coordination) Following-Up Transitioning (Transitional Care) Communicating Post Transition Evaluating
example managment plan of intendance	A comprehensive plan of intendance for an individual client that describes: The client'south problems, needs, and desires, equally determined from the findings of the customer'due south assessment. The strategies, such as treatments and interventions, to be instituted to address the client's problems and needs. The measurable goals – including specific outcomes – to be achieved to demonstrate resolution of the client's problems and needs, the fourth dimension frame(southward) for achieving them, the resource available and to exist used to realize the outcomes, and the desires/motivation of the customer that may accept an touch on the program (CMSA, 2016, p. 32).
payor	The person, agency, or organization that assumes responsibleness for funding the health and human services and resources consumed by a client. The payor may exist the customer, a member of the client's back up system, an employer, a authorities do good program (e.g., Medicare, Medicaid, or TriCare), a commercial insurance agency, or a charitable organization.
practice setting	(Also referred to equally practise site, care setting, or work setting.) The organization or bureau at which instance managers are employed and execute their roles and responsibilities. The do of case direction extends across all settings of the health and human services continuum. These may include but are non limited to payor, provider, government, employer, customs, independent/private, workers' compensation, or a client's dwelling house environment.
professional person discipline	Case managers' formal education, grooming, and specialization or professional background that is necessary and prerequisite for consideration as health and human services practitioners. Also refers to the professional background – such as nursing, medicine, social work, or rehabilitation – that instance managers bring with them into the exercise of case management.
knowledge domain	A collection of information topics associated with health and human services and related subjects. These topics are organized around common themes (domains) to grade loftier-level/abstract concepts that are considered to be essential for constructive and competent performance of case managers. Examples of case direction cognition domains are Quality and Outcomes Evaluation and Measurement, and Intendance Delivery and Reimbursement Methods.
wellness	An individual'south physical, functional, mental, behavioral, emotional, psychosocial, and cognitive status. It refers to the presence or absenteeism of illness, disability, injury, or limitation that requires special management and resolution, including the utilise of health and human services-type interventions or resource. Annotation: Throughout the CMBOK, the term health implies all aspects of wellness equally described in the master term, reflecting a holistic view of the customer'due south condition or situation.
wellness and human services continuum	The range of care that matches the ongoing needs of clients as they are served over time past the Example Direction Procedure and case managers. It includes the appropriate levels and types of intendance – health, medical, financial, legal, psychosocial, and behavioral – across one or more than care settings. The levels of intendance vary in complexity and intensity of healthcare services and resource, including private providers, organizations, and agencies. NOTE: Throughout the CMBOK, the term healthcare refers to and incorporates "wellness and homo services," reflecting the broader community of professionals who serve clients and the continuum of services they provide.
level of care	The intensity and effort of health and human services and care activities required to diagnose, treat, preserve, or maintain clients' wellness. Level of care may vary from to the lowest degree to most circuitous, least to most intense, or prevention and wellness to astute care and services.
customs services and resource	Healthcare programs that offer specific services and resources in a community-based environment as opposed to an institutional setting (i.e., outside the confines of healthcare facilities such as hospitals and nursing homes). These programs either are publicly or privately funded or are charitable in nature.
benefit programs	The sum of services offered by a wellness insurance plan, government agency, or employer to individuals based on some sort of an agreement between the parties (e.grand., employer and employee). Benefits vary based on the programme and may include physician and hospital services, prescriptions, dental and vision intendance, workers' compensation, long-term care, mental and behavioral health, inability and adventitious decease, counseling, and other therapies such as chiropractic care.
benefits	The type of health and human services covered by a health insurance plan (sometimes referred to as health insurance benefits, health benefits, or benefits plan) and as agreed upon between an insurance visitor and an individual enrollee or participant. The term also refers to the amount payable by an insurance company to a claimant or beneficiary under the claimant's specific coverage as stipulated in the health insurance plan.
services	Interventions, medical treatments, diagnostics, and other activities implemented to manage clients' conditions, including health and human services problems and needs. The types of services implemented tin can be found in an individual customer's case direction program of intendance, medical treatment plan, or other related documents as applicable to the healthcare setting and the professional person discipline of the provider of care and services. Notation: The term services is used generically in the CMBOK to include the various types of care and services described in a higher place.

The Case Management Process

The Example Management Procedure consists of nine phases through which instance managers provide intendance to their clients: Screening, Assessing, Stratifying Risk, Planning, Implementing (Intendance Coordination), Post-obit-Upwards, Transitioning (Transitional Care), Communicating Mail Transition, and Evaluating. The overall process is iterative, not-linear, and cyclical, its phases beingness revisited as necessary until the desired outcome is achieved. It also is affected past the intendance setting in which the customer and client's back up system are beingness cared for and the practice setting of the case manager.

Centering on a customer and the client's support arrangement, the Case Management Procedure is holistic in its approach to the direction of the customer's situation and that of the client's support system. It is adaptive both to the case manager's practise setting and to the healthcare setting in which the client receives services.

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The Loftier-Level Case Management Process

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Instance managers navigate the phases of the process with careful consideration of the customer'southward cultural beliefs, interests, wishes, needs, and values. By following the steps, they assistance clients/support systems to:

• Evaluate and understand the care options bachelor to them
• Hold on their intendance goals and priorities
• Decide what is best to meet their needs
• Plant action to achieve their goals and meet their interests/expectations

At the aforementioned time, case managers apply:

• Relevant land and federal laws
• Ethical principles and standards such as the CCMC's Lawmaking of Professional Bear for Case Managers with Standards, Rules, Procedures, and Penalties (CCMC, 2015), which applies to persons holding the CCM® credential
• Accreditation and regulatory standards
• Standards of care and practice such as the CMSA Standards of Practice for Case Management (CMSA, 2016)
• Show-based care or practice guidelines
• Health insurance programme requirements and obligations as appropriate

And at every phase of the Example Management Process, example managers provide vital documentation.

Client Source

Earlier looking more closely at the phases of the Case Management Process, first consider what triggers the process. Y'all begin with the identification of a client. Without a client institute to be in need of instance direction services, you lot have no need to launch the Case Management Procedure.

The client source – that is, how you, every bit case managers, come in contact with clients and/or their support systems – varies based on your practise setting.

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Examples of Client Sources

Care/Exercise Setting	Highlights
Payor-based case manager	May implement the Case Direction Process for a customer upon directly contact via the telephone by the customer/support system or upon referral from other professionals working for the payor system such equally a medical director, a claims adjuster, a clerical person, or a quality/performance improvement specialist.
Acute care setting-based instance manager	May implement the Case Management Process for a client subsequently referral from whatever of the healthcare squad members, including the physician, primary nurse, social worker, consultant, specialist, therapist, dietitian, or managing director. In some organizations, case managers may visit every new access and conduct a high-level review of the client'due south situation for the purpose of identifying whether the client would benefit from case management services.
Community intendance setting-based case manager	May implement the Example Direction Process for a client after referral from the primary care provider or specialty care provider. In some instances, the example manager may initiate the process based on a request from the customer/support system or based on a regulatory obligation such equally health abode requirement for Medicare or Medicaid beneficiaries participating in an accountable care organization or federally qualified healthcare heart.
Vocational rehabilitation or workers' compensation-based case manager	May implement the Case Management Process for a client after referral from the acute- or customs-based instance director or other healthcare providers who accept identified the client would benefit from vocational rehabilitation case management services. In some instances, an employer may refer a client (e.yard., on-the-job injured worker) for vocational rehabilitation as office of the return-to-work plan of intendance.

The Screening Phase

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The Case Direction Process: Screening

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The Screening phase focuses on the review of primal information related to an private'due south health state of affairs in order to place the need for health and human services (case management services). Your objective of the screening equally the case managing director is to determine if your client would do good from such services.
Screening promotes early intervention and the accomplishment of desired outcomes. Central information about your client/back up organization you gather during screening may include the following (to the extent available):

• Run a risk stratification category or course
• Claims data
• Health services utilization
• Past and current wellness status
• Socioeconomic and financial status
• Health insurance coverage
• Dwelling house environment
• Prior services
• Physical, emotional, and cerebral functioning
• Psychosocial network and support organization
• Cocky-intendance ability

The Assessing Phase

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The Case Management Process: Assessing

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The Assessing phase involves the collection of information about a customer's situation like to those reviewed during screening, however to greater depth. The data you lot collect almost your client/support system may include:

• Past and current health conditions
• Service utilization
• Socioeconomic and financial status
• Health insurance plan benefits and coverage
• Home condition and safety
• Availability of prior services
• Concrete, emotional, and cognitive functioning
• Psychosocial network and support system
• Health appointment
• Self-care knowledge and ability
• Readiness for change

You, the example manager, have three master objectives while assessing your client/support system:

1. Identifying the client'south key problems to be addressed, too every bit individual needs and interests
2. Determining the expected care goals and target outcomes
3. Developing a comprehensive case direction plan of intendance that addresses these bug and needs while allowing you to attain the care goals

You seek to ostend or update your client's risk category based on the information you accept gathered. You also may apply two key strategies for your constructive data gathering. Using standardized assessment tools and checklists, y'all:

• Gather the essential data telephonically or through confront-to-face up contact with your customer, the client's support system, and the clinicians involved in your client's intendance.
• Collect necessary data through a review of current and by medical records, personal health records if available, and communication with your client's employer, health insurance program representative, and others as you deem appropriate.

The Stratifying Run a risk Phase

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The Instance Management Process: Stratifying Chance

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The Stratifying Risk phase involves the classification of your client into 1 of three take chances categories – depression, moderate, and high – in order to determine the appropriate level of intervention based on your client'southward situation and interests. This classification allows you to implement targeted chance category-based interventions and treatments that enhance your client'south care interventions and outcomes.

When stratifying your client'south chance, you as the example manager complete a health adventure assessment and biomedical screening based on specific risk factors for your client.

Factors applied in a client's risk stratification may include:

• Presence and number of physical health weather
• Medications intake: number and type (polypharmacy)
• Claret pressure
• Substance, alcohol, or tobacco utilise
• Nutrition and exercise habits
• Claret sugar level and lipids/cholesterol profile
• Emotional, mental, and behavioral health
• Access to intendance and utilization of healthcare services (e.g., emergency department visits or hospitalizations)
• Availability of psychosocial support system
• Gender, race, ethnicity, and age
• Socioeconomic and fiscal state of affairs (eastward.g., limited income, no insurance, underinsurance)
• Other take a chance factors depending on the hazard assessment tool/model applied

In some organizations, such as those that are payor-based, stratifying risks may have identify prior to assessing the client. It too may be completed in an automated manner using determination support systems and based on claims information. In such situations, you lot as the case manager review the automatically generated risk classifications and contact the client accordingly. Y'all may also determine the need for contacting the client based on agreed-upon and nationally recognized algorithms, criteria, and protocols.

It is mutual today to have a adventure nomenclature arrangement that consists of four categories instead of three. The fourth and additional level refers to a modest per centum of clients (i.e., no more than than iii%) whose status is extremely complex and requires an intensive amount of resources and the involvement of multiple healthcare providers with varied specialties. This grouping of patients is usually described equally the "very high" run a risk category. When yous are managing this category of clients, you provide comprehensive instance management services while interacting with such clients at a frequency that exceeds once per month – as high as perhaps weekly.

The Planning Phase

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The Instance Management Process: Planning

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The Planning stage establishes specific objectives, care goals (short- and long-term), and deportment (treatments and services) necessary to meet a customer's needs as identified during the Screening and Assessing phases.

You oftentimes consider the client'south adventure classification or category in the design of the client's plan of intendance.

During the Planning phase, y'all equally the case managing director develop a case management plan of intendance for your client that considers inputs and approvals of the customer/support organisation and the client'southward healthcare providers. Your plan is action-oriented, time-specific, and multidisciplinary in nature. In this plan you accost your client'southward cocky-intendance management needs and care across the continuum, particularly the services needed after a current episode of intendance; for case, care mail infirmary discharge such equally habitation care services.

In add-on, the case management plan of care y'all develop identifies outcomes that are measurable and achievable within a manageable fourth dimension frame and that apply evidenced-based standards and care guidelines. You lot finalize the Planning phase (i.e., development of a final case management plan of care for your client/support system) later on you have received authority for the health and human services from your customer'south payor source and afterward the services and resource needed have been identified.

The Implementing (Care Coordination) Phase

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The Case Management Process: Implementing (Care Coordination)

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The Implementing stage centers on the execution of the specific case management activities and interventions that are necessary for accomplishing the goals set along in your client'due south example direction plan of care. This is commonly known as care coordination.

During this phase, you equally the example manager organize, secure, integrate, and alter (equally needed) the health and human being services and resources necessary to meet your client's needs and interests. Yous also share key information on an ongoing basis with your client and client's back up system, the healthcare providers/clinicians you are collaborating with, your client's health insurance company/payor, and the representatives of customs-based agencies you accept engaged or will be engaging in the customer's care and case management program.

The Following-Upwardly Phase

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The Case Management Process: Following-Up

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The Following-Up phase focuses on the review, evaluation, monitoring, and reassessment of a client's health condition, needs, power for self-intendance, knowledge of condition and treatment regimen, and outcomes of the implemented treatments and interventions. Here your chief objective is to evaluate the appropriateness and effectiveness of your client's case management plan and its effect on your client's health condition and care outcomes.
During this phase, you:

• Gather sufficient data from all relevant sources
• Share information with your customer, customer'due south support system, healthcare providers, and others as appropriate Document in your client'south health record the findings, modifications y'all may accept made to your client's case direction plan, and recommendations for care
• May repeat these activities at frequent intervals and as needed
• Following-upwards may indicate the need for a pocket-sized modification or a consummate modify in the case management plan of care. You use this stage as an opportunity to identify such needed revisions.

The Transitioning (Transitional Care) Phase

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The Instance Management Process: Transitioning (Transitional Intendance)

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The Transitioning phase focuses on moving a client across the health and homo services continuum or levels of care depending on the client's wellness status and the needed services/resource.

During this phase, you equally the case director prepare your client and client'south support system either for discharge from the current care setting/facility to habitation or for transfer to another healthcare facility or a community-based clinician for further intendance. These activities are usually known today as transitional care or transitions of care. In order to maintain continuity of care, you apply this stage'south activities to completely execute your client's transition to the side by side level of care. Yous ensure your client's safe transition through careful advice with fundamental individuals (including sharing of necessary information) at the next level of care or setting, your client and client's back up arrangement, and other members of the healthcare team.

Additionally, yous may:

• Educate your client most post-transition care and needed follow-up
• Summarize what happened during an episode of care
• Secure durable medical equipment (due east.m., glucose meter, scale, walker) and transportation services (if needed) for your client
• Communicate these services to your client, your client'due south support system (such as caregiver), and to primal individuals at the receiving facility or habitation care agency (if applicable) or those individuals assuming responsibility for your client'southward care post transition

The Communicating Post Transition Phase

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The Case Management Process: Communicating Postal service Transition

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The Communicating Post Transition stage involves communicating with a customer/back up organization for the purpose of checking on how things are going mail transition from an episode of care.
Equally the case managing director during this phase, you enquire about your client's comfort with self-care, medications intake, availability of the post-transition services y'all may take arranged for (east.g., visiting nurse services), and presence of any bug or concerns. You also may solicit feedback regarding your client's experience and satisfaction with services during the intendance episode.

During this phase, y'all:

• Follow up on the issues and problems you lot identify during the post-transition communication
• Seek resolution for the issues you identify
• Depending on the outcome or concern you have identified, you may engage other healthcare professionals to attain resolution
• Report the feedback you gather during the communication to key stakeholders such as payors and providers of care

The Evaluating Stage

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The Instance Direction Process: Evaluating

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The Evaluating phase calls for measuring the results of implementing the client's example management plan of intendance (eastward.g., the objectives, goals, treatments and interventions, and render on investment) and their outcome on a client'southward status. In this evaluation, yous focus on several types of outcomes of care:

• Clinical
• Financial
• Quality of life
• Experience and satisfaction with intendance
• Concrete functioning
• Psychosocial and emotional well-being
• Self-care direction ability and health engagement
• Noesis of health condition and plan of care, including medications management

During this stage, you equally the case director generate outcomes reports such equally case summary, quality, cost/billing, satisfaction, outcomes, cost-benefit assay, and return on investment. You also communicate the findings or disseminate the reports to key stakeholders such every bit government agencies (e.k., Centers for Medicare & Medicaid Services), the leadership team, client, payor, providers of care, employers, interdisciplinary team members, risk management staff, quality improvement team members, and others equally deemed appropriate.

Essential Domains of Instance Direction Knowledge

Although case managers practice in a variety of care settings and are from varied backgrounds, the Commission has now defined half-dozen essential noesis domains that encompass the realm of case management piece of work and that use to all care settings, health disciplines, and professional person backgrounds. Each domain is further organized into subdomains.

Domain	Subdomains
Care Delivery and Reimbursement Methods	Case Management Administration and Leadership Example Direction and Processes of Care Instance Management Programs and Models Care Coordination Advice Skills of the Case Manager Transitions of Care Utilization Direction Wholistic Case Management
Psychosocial Concepts and Support Systems	Motivational Interviewing Social Determinants of Health
Rehabilitation Concepts and Strategies	Inability Example Management, Catastrophic Instance Management, and Life Care Planning Essentials of Workers' Compensation Vocational Rehabilitation
Ethical, Legal, and Practice Standards	Ethical Standards for Instance Management Practice – Office I: Review of the CCMC Lawmaking of Professional Conduct for Case Managers Ethical Standards for Example Direction Practice – Function II: Practice Considerations for the CCMC Standards for Professional Conduct Legal Issues related to Case Management Practice
Quality and Outcomes Evaluation and Measurement	Quality Management Value of Case Management Value and Return on Investment Outcomes
Professional person Development and Advancement	Health and Public Policy Scholarship Activities

Care Delivery and Reimbursement Methods

The Care Delivery and Reimbursement Methods domain consists of knowledge associated with the Case Direction Procedure, systems of care provision, resources, and skills needed to ensure the effective and efficient commitment of condom, quality health and human services to clients/back up systems. This domain also includes noesis of reimbursement methods, funding sources, allocation of services and resource, payor systems, and concepts such equally utilization review and direction procedures.

Applying such cognition in the execution of your role and responsibilities every bit case manager enhances your functioning and improves your productivity, which then ultimately results in enhanced care outcomes for both your customer and employer (healthcare organisation) alike.

Success in your case manager's role requires the work of a team: the client, the customer'south back up system, and the healthcare and service providers, including payor representatives and other clinicians.
The Case Direction Team

     © CCMC 2018. All rights reserved.

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The Care Delivery and Reimbursement Methods domain besides focuses on cognition associated with case management administration and leadership, with program pattern and structure, with roles and responsibilities of case managers in diverse settings, and with skills of instance managers (east.g., communication, trouble-solving, conflict resolution, resilience, and others).

Additionally, cognition in this domain is associated with various healthcare delivery systems and models across the continuum of health and man services and example managers' practise settings. It includes knowledge of case direction models, concepts, processes, services, and resource. Moreover, this domain addresses other topics such equally levels of intendance, transitions of care, and collaboration among the various people involved in intendance such as the clients themselves, their back up systems, multi-specialty care providers, community agencies, and payors.

Psychosocial Concepts and Back up Systems

The Psychosocial Concepts and Support Systems domain consists of knowledge associated with the part clients' cultures, values, beliefs, social networks, and support systems play in clients' wellness and well-existence, including health behavior and lifestyle. This domain also focuses on the impact of socioeconomic classes on clients' health weather condition, power for self-care direction, health appointment, health literacy and numeracy, and adherence to treatment regimen.

Additionally, this domain includes knowledge of the example manager's role in addressing issues of underinsurance or lack of insurance, charity care, clients' education regarding health condition and treatment options, counseling and psychosocial back up, and clients' home environments and living arrangements.

Rehabilitation Concepts and Strategies

The Rehabilitation Concepts and Strategies domain consists of knowledge associated with clients' physical and occupational health and functioning, including catastrophic case management, workers' compensation, vocational and disability concepts, strategies, and resource.

This domain also includes cognition of life intendance planning, roles and skills of various healthcare providers in rehabilitation care settings, return-to-work concepts and strategies, types of rehabilitation settings/facilities, and employ of assistive devices or durable medical equipment for rehabilitation and vocational purposes. In add-on, this domain includes regulations pertaining to rehabilitation.

Quality and Outcomes Evaluation and Measurement

The Quality and Outcomes Evaluation and Measurement domain consists of knowledge associated with quality management, accreditation standards, care quality and safety, demonstrating return on investment, and cost-effectiveness. In add-on, this domain includes demonstrating the value of case direction, case load adding, tools such as instance direction plans of care, and regulations related to case management.

Upstanding, Legal, and Exercise Standards

The Ethical, Legal, and Practice Standards domain consists of knowledge about the case manager's role as client advocate, and legal and ethical issues relevant to case management exercise. This domain besides focuses on:

• Codes of ethics and professional person bear for case managers
• Risk direction
• Regulatory and legal requirements
• Ethical practices and principles
• Privacy and confidentiality
• Overall standards of case direction do
• Utilise of standards and guidelines in the management of clients' care
• Strategies for ethical and legal exercise

Professional Development and Advancement

The Professional Development and Advancement domain consists of noesis associated with the roles and responsibilities of example managers in articulating, advancing, and demonstrating the value of case management practice. It also includes topics such as case managers' involvement in scholarship activities (e.g., writing for publication, public speaking, research and utilization of bear witness, grooming and education, and curriculum development), health or public policy work, accountability for ongoing education or learning, maintaining necessary skills and competencies for constructive performance, engagement in practice innovation, and mentoring other case managers.

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Source: https://cmbodyofknowledge.com/content/introduction-case-management-body-knowledge

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