Riassunto
Developed for professionals and firms who are new to the growing field of insurance-based or external case management, this practical handbook focuses on case management in accident/health and property/casualty insurance including workers' compensation. It presents a step-by-step approach to assist both new and experienced case managers. For the novice, it provides information on roles and responsibilities of a case manager, how to start a case management program, a functional description of insurance systems, and information on hiring and training case managers. More experienced case managers will benefit from discussion of effective marketing to help increase business, better supervision of case managers to maintain quality, and fee negotiation for better cost savings through case management.
* Covers all key aspects of healthcare delivery systems, both inpatient and outpatient. * Addresses cutting-edge issues such as the future of case management, disease management, risk management, telephonic vs. onsite case management, and vocational rehabilitation. * Provides a detailed unit on how to set up and operate an effective case management program. * Includes useful appendices that provide sample forms, report formats, checklists, and examples of criteria that eliminates the need to develop new case management tools.
Contenuti
PART I: INTRODUCTION TO CASE MANAGEMENT, THE HEALTH CARE DELIVERY SYSTEM, AND INSURANCE · Case Management: History, Overview, Concepts, and Models · The Role and Qualifications of the Case Manager · The Health Care Delivery System, Managed Care, and Case Management · Insurance: General Principles and Terminology · Lines of Insurance Coverage · Legal Issues in Case Management · PART II: PRACTICAL ASPECTS OF CASE MANAGEMENT · Case Identification, Referral, Screening, and Authorization · On-site versus Telephonic Case Management · Initial Assessment, Interviewing, and Counseling Skills · Working the Case · Writing Case Management Reports · Creativity in Researching Medical and other Issues During Casework · PART III: SETTING UP A CASE MANAGEMENT PROGRAM · Marketing Case Management· Developing a Management Plan for Your Company · The Case Management Office or Unit · Hiring, Training, and Supervision of Case Managers · Risk Management in Case Management · Internal Quality Control · Outcomes Management · PART IV: RELATED ASPECTS OF CASE MANAGEMENT · Vocational Rehabilitation · Vocational Evaluation · The Americans With Disabilities Act · Client Placement and Provider Negotiations · Ethics in Case Management · Disease Management · Addressing Cross-Cultural Issues · Future of Case Management · Appendix 1: Examples of Criteria · Case Management Prenotification List· Information from Intake · Information from Health Coordinators · Clinical Screening Criteria · Generic Screening Criteria For Opening Case Management Cases · Criteria for Determining Order of Precedence for Case Management Services · Appendix 2: Developing and Using Letters and Forms for Casework · Examples of Case Management Forms · Report Writing Formats · Examples of Forms Letters · Appendix 3: Vocational Rehabilitation · The Vocational Rehabilitation/Evaluation Process · Vocational History Form · Job Analysis Form · Labor Market Survey Form · About the Dictionary of Occupational Titles (DOT) · About the Classifications of Jobs (COJ) 1992 Revision · Definitions from the DOT · Physical Capacities Evaluation (PCE) Form · Appendix 4: Case Management Test · Glossary · References
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