Case Managers?? Roles and Functions

The purpose of this national role and function study was to identify the essential activities and necessary knowledge areas for effective case manager practice from the perspective of those currently functioning in various care settings and across diverse professional disciplines. The national study covered all case management practices and/or work settings across the full continuum of health care. This cross-sectional descriptive study used the practice analysis method and online survey research design. It employed a purposive sample of case managers, in which 52,370 individuals received an invitation to participate. Data collection completed over a 4-week period, resulting in 7,668 useable survey responses (nearly a 15% response rate). The study identified the common activities and knowledge areas necessary for competent and effective performance of case managers, as is highlighted in this article, which is the first of a 2-part series on the role and function study. The results informed the needed update of the test specifications for the Certified Case Manager (CCM) certification examination, as will be delineated in Part 2 of the article series, to ensure that it continues to be substantiated in current practice. Of special note are the emergence of specific activity and knowledge domains in the area of case management ethical, legal, and practice standards, and an increase in the number of employers requiring certified case managers to fill vacant positions and compensating them financially for such qualifications. This study helps keep the CCM credentialing examination evidence-based and maintain its validity for evaluating competency of case managers. Specifically, the study identified essential activities and knowledge domains that define competent case management practice. Findings can be used for developing programs and curricula for the training and development of case managers. The study instrument also can be used for further research of case management practice.

To describe the practice of case managers in diverse settings with special focus on the roles and functions that they engage in during an average work day. Results were also used to validate and revise as indicated in the blueprint of the certification examination of the credential Certified Case Manager (CCM). The study covered all of the various case management practice settings. This cross-sectional descriptive study applied the practice analysis method and survey research design. It also employed a purposive nonrandomized sampling procedure that resulted in 6,909 total participants. Data collection was completed between May and July 2009. The survey instrument used consisted of 209 items that addressed background and demographics, case management activities, and knowledge areas. The case management professionals who participated in this study had similar perceptions of the essential activities and knowledge aspects of their practice except for those who are vocational rehabilitation and work adjustment specialists and those who practice in the life care planning and disability management settings. The study also resulted in the identification of 6 essential activity and 6 knowledge area domains. This study described the current practice of case management in diverse settings and by different health care professionals who assume the case manager's role. It also forecasted what practice changes might occur in the next few years. In addition, it identified the essential activities and knowledge areas required for effective and competent performance of case managers. These findings provided the evidence of the CCM certification examination and demonstrated that the structure or blueprint of the examination was developed on the basis of rigorous research. In addition, findings of this study can be used for further research in case management and developing training and education curricula for the advancement of case managers.

Hospitals are catching up to the business world in the introduction of technology systems that support professional practice and workflow. The field of case management is highly complex and interrelates with diverse groups in diverse locations. The last few years have seen the introduction of Workflow Technology Tools, which can improve the quality and efficiency of discharge planning by the case manager. Despite the availability of these wonderful new programs, many case managers are hesitant to adopt the new technology and workflow. For a myriad of reasons, a computer-based workflow system can seem like a brick wall. This article discusses, from a practitioner's point of view, how professionals can gain confidence and skill to get around the brick wall and join the future.

The field of case management is experiencing a rise in the number of certified case managers and certified (or accredited) programs in case and disease management. However, not every practicing case manager, employer, payer, or client is aware of the value of certification. In addition, there exists some confusion about the difference between "individual" and "institution" certification; sometimes they are erroneously used as interchangeable terms. This article emphasizes the value of case management certification and its necessity, and clarifies the difference between individual and institution certification.

Mental health case managers comprise a large workforce who help patients who struggle with complex mental illnesses and unmet needs with respect to the social determinants of health. This mixed-methods capacity-building pilot examined the feasibility, experiences, and outcomes of training community-based mental health case managers to integrate evidence-based psychotherapy principles into their case conceptualization and management practices. Case-based, once-weekly, group consultations and training in applied therapeutic principles from mentalizing, interpersonal psychotherapy, motivational interviewing, and other evidence-based psychotherapies were provided to case managers over 8 months. A trauma-informed and culturally sensitive approach was emphasized to improve therapeutic alliances and to foster adaptive expertise and an appreciation of individual patient differences. Qualitative analyses of focus groups and individualized interviews identified a shift toward being more reflective rather than reactive, with improved empathy, patient engagement, morale, and confidence resulting from the training (N = 16). Self-reported pre-post counseling self-efficacy changes revealed significant improvements overall, driven by improved microskills and an ability to deal with challenging client behaviors (N = 10; P < 0.05). This pilot demonstrated that case-based consultations and training of mental health case managers within a community-of-practice in trauma-informed, culturally sensitive application of evidence-supported psychotherapy principles were feasible and acceptable with scalable potential to improve case managers' counseling self-efficacy, reflective capacity, empathy, and morale. Further research in this area is needed with a larger sample, and patient and health systems outcomes.

In case management, the power imbalance between practitioners and clients has been pointed out as a structural problem that restricts core values such as client centeredness, participation, and mutuality. This study analyzed how power imbalances are formed, operated, and reproduced in the case management field, focusing on Foucault's concept of governmentality and Bourdieu's concept of symbolic violence. As a result of the analysis, neoliberal welfare discourse, institutionalized practice structure, practitioner's authority and professionalism act as key factors constituting the power imbalance, and it was analyzed that this is carried out through practical skills such as performance-oriented intervention, standardized procedures, and practitioner's speech authority. It was found that this power relationship forms a hierarchy through specific discourse, institutions, and practical skills from the beginning of practice, and constitutes and reproduces the practitioner and the client as the subject of discipline and compliance, respectively. The power imbalance in case management has been identified as a problem of structured power mechanisms throughout practice beyond simple ethical issues or limitations of intervention skills.

The purpose of this study was to identify changes in case management within public sector mental health, following the implementation of managed care. Case managers in the State of Oregon completed surveys in 1992 and 2000 regarding aspects of case management. Results showed that current case managers are more experienced and expect longer tenure than previously. Caseload sizes have increased. Meanwhile, case managers' activities and functions have not changed across time periods. The results suggest that mental health personnel have changed in the past decade, though the practice of case management has remained largely the same.

This study is designed to explore the experience of the supervisors in case management practice, working as case manager in a Community Welfare Center. The data was collected from 10 supervisors in case management team through in-depth interview. The data was analyzed by the procedures of qualitative method involving Strauss &amp; Corbin, derived 7 top categories. They are as the following: Discovering and recognizing myself; Relearn case management through supervision; Being hard to maintain the continuity of supervision; Finding the roles as a Case Management Supervisor; Case management is still difficult, even for case management supervisors; working with supervisees; Not staying for change and growth. The empirical meaning of case management supervision on the capacity building of supervisors is understood as the process of identifying their desire for growth through self-insight as a case manager. Based on these analysis, the practical alternatives area are suggested.

To describe the methodology of developing a competency assessment process and tools for case management associates in a large multifacility acute care setting. Nurse case managers practice in a variety of settings and may function in teams that include the medical social workers, utilization review specialists, appeals coordinators, and language interpreters. As professionals and licensed associates, case managers are responsible for their own professional and clinical development. Competency assessment can take place in any care setting and utilized by all case managers. Understanding adult learning principles and the role transition from caregiver to case manager, competencies were developed that were grounded in professional case management standards of practice. The competency assessment process is based on a "continuum" and should be approached with the end result in mind, promoting professionalism and accountability for one's own development. The practice of case management is a reflection of the organization's mission vision, values, and strategic goals. Incorporating these initiatives, along with the professional scope and standards of practice for case management, provides a well-rounded opportunity for case managers to develop collaborative leadership skills necessary to perform in today's robust healthcare environment.

This study aims to explore how general social welfare center practitioners working with a community-centered approach implement case management and identify necessary changes for better practices. The core research questions—“Case management practice experiences in community-centered welfare projects” and “Changes needed for improved case management in community-centered welfare projects”—revealed two sub-themes: “Our institution’s unique case management approach, reaching out to walk alongside clients throughout their lives” and “Empathizing with the sincerity and dedication of practitioners striving to implement case management based on the value of social welfare centers.” Based on the findings, this study suggests strengthening on-site training on the essence of case management practice, choosing and focusing on what they can do the best from different tasks and projects, increasing flexibility in the case management evaluation method for community-based practices, and improving policies to allow diverse and flexible operational autonomy.

(1997). Case Management in Practice. Journal of Prevention & Intervention in the Community: Vol. 15, No. 2, pp. 67-82.

New long-term care legislation and managed care legitimate case management for gatekeeping and advocacy for frail elderly. Qualitative in-depth interviews with case managers who are social workers and nurses were used to address the question: To what extent is client-centered theory reflected in case management practice? Differences between reported client-centered theory and directive practice were identified by five themes: (a) client wishes versus system constraints; (b) the paradox of working to keep clients home versus the perceived inevitability of nursing home placement; (c) client centeredness versus the case manager's care plan; (d) client self-determination versus strategies of persuasion; (e) informing the client about case management versus the reality of practice. Ethical implications, competing demands, and environmental constraints are discussed. Suggestions are made to better integrate client-centered theory with directive practice.

WHO recommends prompt diagnosis and quinine plus clindamycin for treatment of uncomplicated malaria in the first trimester and artemisinin-based combination therapies in subsequent trimesters. We undertook a systematic review of women's access to and healthcare provider adherence to WHO case management policy for malaria in pregnant women. We searched the Malaria in Pregnancy Library, the Global Health Database, and the International Network for the Rational Use of Drugs Bibliography from 1 January 2006 to 3 April 2014, without language restriction. Data were appraised for quality and content. Frequencies of women's and healthcare providers' practices were explored using narrative synthesis and random effect meta-analysis. Barriers to women's access and providers' adherence to policy were explored by content analysis using NVivo. Determinants of women's access and providers' case management practices were extracted and compared across studies. We did not perform a meta-ethnography. Thirty-seven studies were included, conducted in Africa (30), Asia (4), Yemen (1), and Brazil (2). One- to three-quarters of women reported malaria episodes during pregnancy, of whom treatment was sought by >85%. Barriers to access among women included poor knowledge of drug safety, prohibitive costs, and self-treatment practices, used by 5%-40% of women. Determinants of women's treatment-seeking behaviour were education and previous experience of miscarriage and antenatal care. Healthcare provider reliance on clinical diagnosis and poor adherence to treatment policy, especially in first versus other trimesters (28%, 95% CI 14%-47%, versus 72%, 95% CI 39%-91%, p = 0.02), was consistently reported. Prescribing practices were driven by concerns over side effects and drug safety, patient preference, drug availability, and cost. Determinants of provider practices were access to training and facility type (public versus private). Findings were limited by the availability, quality, scope, and methodological inconsistencies of the included studies. A systematic assessment of the extent of substandard case management practices of malaria in pregnancy is required, as well as quality improvement interventions that reach all providers administering antimalarial drugs in the community. Pregnant women need access to information on which anti-malarial drugs are safe to use at different stages of pregnancy. Please see later in the article for the Editors' Summary.

Case management is a widely applied and recognized approach in healthcare, social work, business, and management. However, it lacks a unified definition or standardized framework, which limits its practical application and consistency across sectors. The growing complexity of modern challenges, including digitalization, interdisciplinary demands, and crisis situations like the war in Ukraine, underscores the need for a clear conceptual understanding and universal methodologies for implementing case management in diverse fields. This study focuses on analyzing scientific approaches to defining case management, its structural components, and stages, while exploring its potential for further development in contemporary and crisis-driven contexts. The research employs an interdisciplinary methodology, combining literature reviews, legislative analysis, and real-world applications of case management during wartime. Insights are drawn from international and Ukrainian scholarly perspectives across healthcare, social work, business, and law. Legislative documents, such as Ukrainian laws on social services, are analyzed alongside empirical examples from business and social projects. Methods of synthesis, modeling, and generalization are used to propose practical recommendations for adapting case management to address modern and crisis-specific challenges. The findings identify five primary approaches to defining case management: functional-processual, client-centered, interdisciplinary, context-specific, and legal- regulatory. Each highlights a structured process consisting of needs assessment, planning, coordination, implementation, monitoring, and case closure. A flexible algorithm has been developed, enabling case management practices to adapt to the unique needs of different sectors. Key challenges include digitalization, interdisciplinary collaboration, and cultural sensitivity, particularly under wartime conditions in Ukraine. Value of case management lies in its ability to efficiently integrate resources and to address diverse client needs, making it critical for business support, crisis management, social services, and healthcare in unstable environments. This research emphasizes the need to establish universal standards for case management across industries while tailoring practices to local and crisis-specific contexts. Future studies should focus on leveraging digital tools, such as automated platforms and AI, and addressing intercultural and globalization challenges. These advancements could ensure greater adaptability and effectiveness of case management in diverse and rapidly changing environments.

To explore strategies for improving patient throughput and to redesign case management processes to facilitate level of care transitions and safe discharges. Large Urban Medical Center in South Los Angeles County, with 384 licensed beds that services poor, underserved communities. Both qualitative and quantitative methods were applied. Combined theoretical frameworks were used for needs assessment, intervention strategies, and change management. Observations, interviews, surveys, and database extraction methods were used. The sample consisted of case management staff members and several other staff from nursing, social work, and emergency department staff. Postintervention measures indicated improvement in reimbursements for services, reduction in length of stay, increased productivity, improved patients' access to care, and avoiding unnecessary readmission or emergency department visits. Effective change management strategies must consider multiple factors that influence daily operations and service delivery. Creating accountability by using performance measures associated with patient transitions is highlighted by the case study results. The authors developed a process model to assist in identifying and tracking outcome measures related to patient throughput, front-end assessments, and effective patient care transitions. This model can be used in future research to further investigate best case management practices.