Nursing Case Management - Essay Example

The case manager will most probably be a social worker, an allied health professional, or a qualified nurse. 

Their functions include planning and proactively monitoring and forecasting the changing requirements of the individual, coordinating his\her information regarding the care across all parts of the social and health care system, coordinating the care delivered to a patient group, facilitating communications between the hierarchies and care providers, overseeing the follow up of consultations and ensuring the linkage to other services, eliminating intervention and task duplication and ensuring implementation of the plans and they're following up (Mullahy, 1998). In summary, their functions can be generalized into four basics:

1. Planning.
2. Organizing.
3. Leading.
4. Controlling.

A case manager should be possessing competencies in clinical training and have background knowledge of the job, communication and negotiation skills are imperative in such a job. Case managers need to be able to satisfactorily educate the patients and care providers. Possession of dexterity and in-depth knowledge of ethics plus a strong character can help a case manager to voice dissidence when it is unavoidable. The case manager must be a strong problem-solver so that he can quickly and aptly solve technical, organizational and relational problems which might arise and so that he can avoid any variances to the plan all the way in its anticipated duration (Steinberg, 1996).

Other competencies that a case manager shows are an aptitude for working in a team and a propensity for meeting hosting. Significant decision-making and leadership qualities are central to this role. A case manager has to be able to assert her belief in the case and communicate effectively to get others to follow the guidelines of the case management and adhere to them. Investigative skills play an important role in the case manager’s profile as they help him in overseeing, evaluating and correcting the implementation of the clinical pathway plans, the final results, the quality of care being delivered and the strengths\weaknesses of the system. The case manager must be able to write effectively and clearly. The case manager must have a working knowledge of the calculations used for cost-benefit analysis, case-mix groups and of the principles used for risk management, and quality of care assessments, based on the system in place at the workplace (Flarey, 1996).

The various areas where the HMO can carry out quality studies are low customer retention, inaccurate reporting, competitor tracking, increasing costs of claims and the decrease in the quality of service.