Areas of Optimal Case Manager Effectiveness

Reducing costs

    • Avoiding test/consult delays

    • Avoiding prolonged use of IV antibiotics

    • Decreasing inappropriate high-cost lab, radiology, pharmacy, and other medical orders

    • Avoiding unauthorized treatments

    • Expediting discharge process on admission to prevent increased LOS

    • Negotiation with payers to maximize patient funds

    • Suggesting alternative treatment plans/appropriate level of care

    • Monitoring costs

Enhancing quality clinical outcomes

    • Synthesizing other disciplines’ assessment findings and completing an expanded assessment of the patient’s and family’s needs on admission

    • Teaching patients and families prior to, during, and post-discharge

    • Coordinating the multidisciplinary team under the direction of the MD to promote achievement of desired patient outcomes

    • Monitoring patients’ progress toward expected outcomes

    • Anticipating an emerging problem and acting quickly to manage an evolving clinical picture

    • Preventing patient, practitioner, and system variances when possible

    • Monitoring, tracking, and analyzing aggregate complex patient population quality data to improve process/outcomes of care

Enhancing patient, family, and provider satisfaction

    • Assist patient in understanding treatment choices, alternatives, benefits, and risks

    • Orchestrate the "system" for the patient

    • Work with health care team to ensure that patient and family are fully informed and in agreement with the plan of care

    • Provide 24-hour on-call availability to MD, patient, and health care team

    • Establish working relationships with referral sources

    • Communicate to other health care providers as appropriate to coordinate patient care

    • Discuss patient’s and family’s satisfaction with them, and respond to complaints appropriately

    • Monitor, track, and analyze satisfaction data