This book offers a comprehensive exploration of the roles of nursing and social work, with a specific focus on the multiple facets of the Case Management, and provides readers with a wealth of knowledge and insights for the practical application of the theory behind these roles. Case management encompasses the identification and engagement of patients through the assessment and care planning steps, and culminates in monitoring the care described in the care plan and ultimately measurably achieving the targeted outcomes. Case management in nursing is an important approach to help patients locate and manage health resources as well as to enhance effective communication among patients, families, and health systems. Nurses' role as case managers has been proven effective in reducing healthcare costs among patients. The book uses a practical approach to assist nurses, social workers, and other healthcare professionals in understanding the important role of the Case Manager. The author includes numerous real-world examples and case studies that illustrate the application of theoretical concepts. This not only helps to reinforce understanding but also demonstrates the relevance of the material in everyday situations. By bridging the gap between theory and practice, this textbook equips the reader with the tools they need to apply the knowledge gained effectively.
Grounding the information in evidence-based practice and informed by years of experience, drawing from a diverse range of sources, including the latest updates to regulations surrounding the role, this approach provides a well-rounded perspective on the topic, ensuring the readers receive accurate and up-to-date information, which is crucial for making informed decisions.
Its combination of accessible language, practical examples, and real-world experience makes this book a must-read for both novices and experts alike. Whether you are a student or a professional, this book will provide you with the knowledge and skills you need to succeed.
Overview of Case Management.- Rules and Regulations Impacting Case
Management.- Case Management Settings.- Roles of Utilization Review
Team.- Roles with Case Management to Support Patient Throughput.- Reporting
and Monitoring.- Case Management as a Profession.- Looking to the
Future.- Workflows.- Education Tip Sheets.- Conclusion.
Shari Garceau is an independent contractor working with healthcare providers and organizations across public and private institutions to address complexities in Case Management processes, leveraging technology-led services that drive innovation, growth, and organizational resilience. She is an experienced RN with over 20 years of experience in the healthcare field, specializing in case management, utilization review, revenue cycle, clinical documentation, quality, risk, and process improvements for more than 15 years. She is a strategic leader who has successfully restructured case management and utilization review departments across various healthcare systems.
Her active involvement with the American Case Management Association (ACMA) and the Case Management Society of America (CMSA) underscores her dedication to improving patient care and advocating for coverage benefits through healthcare legislation. Shari is known for her compassionate and collaborative approach, excelling in clinical documentation analysis, staff education, and fostering teamwork among case management personnel.
As a subject matter expert in case management, care coordination, utilization review, revenue cycle management, payer relations, quality, and risk, she has a proven ability to identify and implement process improvements that align with quality and compliance standards. Shari has also taken on roles as a CMS compliance officer and lead educator, developing onboarding and continuing education programs to prepare healthcare facilities for regulatory surveys.
Her comprehensive experience and dedication enable her to effectively lead teams and elevate the standards of care within the healthcare industry.
