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Overview
The majority of existing texts address hospital case management as a ‘nursing practice.’ And while it is true that most hospital case managers are, in fact, nurses, few of them are responsible for clinical care. This text addresses the role of the hospital case manager from a business perspective rather than a nursing perspective. It speaks to the relationship the case manager has with the executive team, managed care contracting office, decision support specialists, medical records staff, as well as the medical staff and clinical providers and reveals the value of engaging all of them as allies in pursuit of global objectives on behalf of every patient.
In my years of experience as a hospital-based nurse administrator responsible for Case Management services, I have never found a resource as relevant, concise, and straightforward as this one. Stefani and Marianne speak to the issues and challenges associated with planning, re-designing, and sustaining a hospital-based Case Management program as no one else has. Without a doubt, this book will be an invaluable reference for program planners and administrators for years to come. I am grateful to J&B for selecting this book for publication and am very pleased to recommend it to others.
—Paula Radell, RN, MSN
Director of Quality Management
Chesapeake General Hospital
KEY FEATURES
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Explores the premise that the business of healthcare must be the business of case managers
- Makes a case that today’s healthcare crisis demands a radical new approach to hospital case management
- Establishes the rationale and provides the resources to plan and implement an innovative clinical resource management model of hospital case management
- Offers practical tips on staffing and assignments.
- Shows how to create an outcome report to demonstrate value to the hospital executives
- Provides ‘best practice’ alternatives from real life situations.
- Offers a practical alternative to the traditional UR/DCP model
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Includes real life samples of tools and resources
- Includes guest commentaries at the end of each chapter from people who ‘live’ hospital case management
TABLE OF CONTENTS
Part One: The Healthcare
Environment
Chapter 1: Background and
Business
Chapter 2: Compliance and Regulatory Issues
Chapter 3: Readiness for Case Management
Part Two: Practice
Framework
Chapter 4: Moving in the
Right Direction
Chapter 5: Map for Action
Chapter 6: Building a Case Management Team
Part Three: Operations
and Management
Chapter 7: Clinical Management
Initiatives
Chapter 8: Resource Management Initiatives
Chapter 9: Putting the Pieces Together
Chapter 10: Case Management Program Outcomes
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