CMSA Core Curriculum for Case Management

Name: CMSA Core Curriculum for Case Management
Brand: Wolters Kluwer Health
Price: 115.99 EUR
Availability: OnlineOnly

Hussein M. Tahan Teresa M. Treiger(Author)

Wolters Kluwer Health (Publisher)

1st Edition

Published on 5. July 2016

744 pages

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978-1-4963-5189-0 (ISBN)

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The fully updated CMSA Core Curriculum for Case Management, 3rd edition, is the definitive roadmap to an informed, effective, collaborative case management practice. This comprehensive, expertly-written guide provides those directly or indirectly involved in case management with information about best practices, descriptions of key terms, essential skills, and tools that fulfill the current Case Management Society of America s (CMSA) standards and requirements. Addressing the full spectrum of healthcare professional roles and environments, this is both a crucial certification study guide and vital clinical resource for the case management professionals in all specialty areas, from students to veteran case managers. This unique resource provides the core knowledge needed for safe, cost-effective case management with the following features NEW text boxes highlighting key information and vital practices in each chapterNEW and updated Standards of Practice implications in each chapterNEW and updated content on transitions of care, community-based care, care coordination, Value-Based Purchasing, ethics and social media, the impacts of health care reform, and digital technologyNEW and updated content on accreditation in case managementNEW chapter that lists key additional resources, by topicOfficial publication of the Case Management Society of America, connecting CMSA core curriculum to current CMSA Standards of PracticeEasy-to-grasp, detailed topical outline format for quick scan of topicsComplete, updated core knowledge required of case managers, with expert descriptions and direction on areas including:Case management roles, functions, tools, and processesPlans, clinical pathways, and use of technologyTransitional planningUtilization management and resource managementLeadership skills and conceptsQuality and outcomes management, legal and ethical issuesEducation, training, and certificationHealth care insurance, benefits, and reimbursement systemsPractice settings and throughputInterdisciplinary teams needs in: hospitals, community clinics, private practice, acute care, home care, long-term care and rehab settings, palliative care, and hospice settingsUp-to-date guidance on case management specialty practices, including: nursing, life care planning, workers compensation, disability management, care of the elderly, behavioral health, transitions of care, subacute and long-term care, utilization review/management, primary care and medical/health home, and moreEssential content for academic reference, training, certification study, case management models design, performance or program evaluation

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Content

Cover
Half Title
Series Title
Title
Copyright
Dedication
Contributors
Reviewers
Foreword
Preface
Acknowledgments
Contents
SECTION 1 The Foundation of Case Management Practice
CHAPTER 1 Introduction to the CMSA Core Curriculum for Case Management
Introduction
Descriptions of Key Terms
Applicability of the Core Curriculum to CMSA's Standards of Practice for Case Management
Historical Perspective on CMSA's Standards of Practice for Case Management
Select Definitions of Case Management
Philosophy of Case Management
Guiding Principles of Case Management
The Case Management Team
CHAPTER 2 History and Evolution of Case Management
Introduction
Descriptions of Key Terms
Applicability to CMSA'S Standards of Practice
Factors for the Rapid Growth of Case Management
Professional Development of Case Management Practice
Purposes and Goals of Case Management
Philosophical Tenets of Case Management
Case Management Knowledge Domains
Case Management Target Populations
Case Management Versus Other Job Titles
CHAPTER 3 Health Care Insurance, Benefits, and Reimbursement Systems
Introduction
Descriptions of Key Terms
Applicability to CMSA's Standards of Practice
Driving Forces Behind Health Care Reimbursement Systems
Types of Insurance
Components of Health Care Reimbursement
Health Care Delivery Systems
Reimbursement Methods
Challenges with Health Care Reimbursement
Legal Issues Impacting Managed Care
Strategies in Managed Care
Compliance Considerations for Case Managers
Reimbursement Implications for Case Managers
CHAPTER 4 Case Management Practice Settings
Introduction
Descriptions of Key Terms
Applicability to CMSA's Standards of Practice
Case Management Practice Settings
Telephonic Case Management
Case Management in the Payer-Based Settings or Insurance Companies
Case Management in the Community Care Setting
Case Management in the Ambulatory Clinic and Outpatient Care Setting
Case Management in the Patient-Centered Medical Home Care Setting
Case Management in the Admitting Department
Case Management in the Perioperative Services
Independent/Private Case Management
Case Management in the Emergency Department
Patient Flow, Throughput, and Case Management
Transitions of Care and Case Management
Role of the Case Manager in Patient Safety and Prevention of Medical Errors During Transitions
SECTION 2 Case Management and the Health Care Continuum
CHAPTER 5 Case Management in the Acute Care Setting
Introduction
Descriptions of Key Terms
Applicability to CMSA's Standards of Practice
Background/Historical Perspective
Distinguishing the Hospital Venue
Physician Partnerships
Designing a Case Management Model for Your Hospital
Case Management Program Infrastructure
Workflow
Program Operations
Outcomes
CHAPTER 6 Case Management in the Community and Postacute Care Settings
Introduction
Descriptions of Key Terms
Applicability to CMSA's Standards of Practice
Federally Qualified Health Centers
Patient-Centered Medical Home
Accountable Care Organizations
Roles of Case Managers in FQHCs, PCMHs, and ACOs
Long-Term Care
Rehabilitation Levels of Care
Rehabilitation Services in Non-Inpatient Care Settings
Nonmedical Levels of Care
Respite Care
Financial Aspects of Long-Term and Rehabilitation Care Settings
Case Management Roles in Long-Term and Acute Rehabilitation Care Settings
Resources for the Care of the Elderly
The Geriatric and Older Adult Patient
Identification of High-Risk Geriatric Patients
Comprehensive Geriatric Assessment
Geriatric Assessment for Placement of the Geriatric Patient
CHAPTER 7 Case Management in the Home Care Setting
Introduction
Descriptions of Key Terms
Applicability to CMSA's Standards of Practice
The Role of the Hospital-Based Interdisciplinary Health Care Team
Home Health Care Visits
Reimbursement for Home Health Care Services
Home Care Nursing Services
Home Care Rehabilitation Services
Durable Medical Equipment and Other Services
Home Care Social Work Services
The Role of the Hospital-Based Case Manager
The Role of the Community-Based Case Manager
Savings, Safety, and Satisfaction
CHAPTER 8 Case Management in the Palliative and Hospice Care Settings
Introduction
Descriptions of Key Terms
Applicability to CMSA's Standards of Practice
Palliative Care
Hospice Care
Guiding Principles and Goals of Palliative and Hospice Care Programs
Scope of Palliative and Hospice Care and Services
Advance Directives and Health Care Proxies
Case Management Services in Palliative and Hospice Care Programs
CHAPTER 9 Case Management in the Remote and Rural Care Settings
Introduction
Descriptions of Key Terms
Applicability to CMSA's Standards of Practice
Understanding Designation of Areas Within United States
Rural Culture Health Care Considerations
Rural Case Management Programs and Services
Behavioral Health Care in Rural Areas
The Patient Protection and Affordable Care Act and Rural Case Management
CHAPTER 10 Transitional Care and Case Management
Introduction
Applicability to CMSA's Standards of Practice
Descriptions of Key Terms
NTOCC Care Transitions Bundle: Seven Essential Intervention Categories
Legislative and Regulatory Considerations Pertaining to Transitions of Care
Transition of Care Models and Delivery Systems
Transitions of Care and Implications for Case Management Practice
Roles and Functions Associated with Transitions of Care
Reimbursement Issues
Certification and Accreditation in Transitions of Care
SECTION 3 Roles, Functions, and Essential Practice Considerations for Case Managers
CHAPTER 11 The Roles, Functions, and Activities of Case Management
Introduction
Descriptions of Key Terms
Applicability to CMSA'S Standards of Practice
Background
Case Management Roles
Case Management Functions and Activities
Case Management Knowledge for Practice and Qualifications
Case Management Knowledge and Skills According to the American Nurses Credentialing Center
Conclusion
CHAPTER 12 The Case Management Process
Introduction
Descriptions of Key Terms
Applicability to CMSA's Standards of Practice
Steps of the Case Management Process
Special Actions Occurring Throughout the Case Management Process
CHAPTER 13 Transitional Planning and Transitions of Care
Introduction
Descriptions of Key Terms
Applicability to CMSA's Standards of Practice
Transitional Planning as it Relates to Continuity of Care
Federal Conditions of Participation that Influence Transitional Care From Acute Care Hospitals
Other Selected Federal Rules that have Significance in Transition Planning
Factors that Impact Case Management in Cross-Setting Measures
Selected Levels of Care to Which Inpatients are Referred
The Role of the Case Manager in the Process of Transitional Planning
Value-Based Purchasing and Impact on Transition Management and Readmissions
Case Manager and Managing Care Transitions
CHAPTER 14 Resource and Utilization Management
Introduction
Descriptions of Key Terms
Applicability to CMSA'S Standards of Practice
UM Program and Process
UM Team
Certifications Related to UM and UR
UM Criteria and Strategies
UM Clinical Review Criteria and Guidelines
Focused UM
Denials of Admissions and Services
Adverse Review Determination
Medical Review Outcomes
Appeal Process
UM Performance Reporting
Key Regulatory and Accreditation Bodies Associated with the UM Process
UM Regulatory and Accreditation Processes
Certification Programs in UR or UM
CHAPTER 15 Case Management and Use of Technology
Introduction
Descriptions of Key Terms
Applicability to CMSA'S Standards of Practice
Health Information Technology and Case Management Information Systems
Goals, Benefits, and Limitations of Case Management Information System (CMIS)
CMIS and Case Management Informatics in Support of Consistency and Standards of Care
Using CMIS to Measure Effectiveness of Case Management Intervention
The Evolution and Delivery of Telehealth Interventions
Telehealth Legislation
Barriers to Telehealth
Evaluation of Web Sites for Professional and Patient Use
HIT Solutions in Support of Case Management
CHAPTER 16 Case Manager's Role Leadership and Accountability
Introduction
Descriptions of Key Terms
Applicability to CMSA's Standards of Practice
Accountability
Leadership Styles
Leadership Skills
Negotiation Skills
Delegation Skills
Communication Skills for Quality and Patient Safety
Critical Thinking and Decision-Making
The Ethics of Decision-Making
Financial/Cost-Benefit Analysis
Case Management Outcomes in the Supervisory Role
Case Managers as Change Agents
Case Managers and Motivational Interviewing
CHAPTER 17 Professional Development, Certification, and Accreditation in Case Management
Introduction
Descriptions of Key Terms
Applicability to CMSA's Standards of Practice
Education and Training of Case Managers
Consensus Areas for Case Management Education: Core Components
Approaches to Case Management Education and Training
Credentialing in Case Management
Overview of Certification in Case Management
Select Certifications in Case Management
URAC Accreditation of Organizations Performing Case Management
NCQA Accreditation in Case Management
Differentiating Individual from Organizational Certification
SECTION 4 Professional Obligations in Case Management
CHAPTER 18 Ethics and General Case Management Practice
Introduction
Descriptions of Key Terms
Applicability to CMSA's Standards of Practice
Ethical Decision Making and the Case Manager
Ethical Theories
Ethical Principles and Decision Making
Ethical Responsibilities Particularly Affecting Case Managers
Strategies for Maintaining Ethical Behavior
CHAPTER 19 Ethical Use of Case Management Technology
Introduction
Descriptions of Key Terms
Applicability to CMSA'S Standards of Practice
Transition in Modes of Patient and Professional Interaction
Electronic Communication
Social Media
To Where Should Your Ethical Compass Point?
CHAPTER 20 Legal Considerations in Case Management
Introduction
Descriptions of Key Terms
Applicability to CMSA'S Standards of Practice
Background
Regulatory Compliance
Contracts
The Case Manager and the Legal Community
Frequently Asked Questions
CHAPTER 21 Use of Effective Case Management Plans
Introduction
Descriptions of Key Terms
Applicability to CMSA'S Standards of Practice
Case Management Care Planning and Plans of Care
Case Management Plan Development Begins with Patient Assessment
Case Management Plan Development-Data Gathering Format
Case Management Plan Development Strategies
Problem List Identification
Case Management Plan Implementation
Incorporating Evidence-Based Guidelines in Case Management Practice
Clinical Pathways
Algorithms
Evidence-based Decision Support Criteria
Benefits of Case Management Plans
Case Management and Utilization Management
CHAPTER 22 Quality and Outcomes Management in Case Management
Introduction
Descriptions of Key Terms
Applicability to CMSA's Standards of Practice
Defining Outcomes Management and Measurement
Rationale for Outcomes Management
Characteristics of Effective Outcome Measures
Outcome Measures Selection and Development
Case Management-Specific Outcomes
Incorporating Outcomes Measurement into Case Management Practice
Common Issues in Outcomes Reporting
SECTION 5 Select Specialty Practices in Case Management
CHAPTER 23 Behavioral Health and Integrated Case Management
Introduction
Descriptions of Key Terms
Behavioral Health Case Management Models
Applicability to CMSA'S Standards of Practice
Behavioral Health Care Conditions and Implications for Case Management
Challenges in Behavioral Health Case Management
Treatment Settings and Behavioral Health Case Management
Roles and Functions of the Behavioral Health Case Manager
How Psychological Factors Impact Medical Conditions and Integrated Care Management
Reimbursement Issues
Integrated Case Management
Appendix A-Suicide Practice Protocol
Appendix B-Case Management Approaches for Patients with Low Self-Care States
CHAPTER 24 Workers' Compensation Case Management
Introduction
Descriptions of Key Terms
Applicability to CMSA's Standards of Practice
Primary Goals of Workers' Compensation Programs
Understanding the Impact of Workers' Compensation Costs
Fitting the Pieces Together: Medical Case Management in the Workers' Compensation System
Key Stakeholders in Workers' Compensation
Workers' Compensation Laws That Directly Affect Case Management Practice
Practicing the Case Management Process Within the Workers' Compensation System
Requirements for Workers' Compensation Case Managers Roles and Employment Settings
Scope of Medical Management in Workers' Compensation Settings
Applying the Case Management Process
Workers' Compensation Referrals for Return to Work
Ethical Considerations for Workers' Compensation Case Managers
Legal Issues for the Workers' Compensation Case Manager
Trends in Workers' Compensation Case Management
Medical Cost Containment Programs
Federal Laws Affecting Workers' Compensation Case Management
Documenting Quality of Services Using Outcome Measurements
CHAPTER 25 Disability and Occupational Health Case Management
Introduction
Descriptions of Key Terms
Applicability to CMSA's Standards of Practice
Perspectives on Disability
Components of Disability Case Management Programs
Challenges to Disability Case Management
The Americans with Disabilities Act (ADA)
Resources for Disability Case Management Programs
Integrated Disability Case Management Strategies
Occupational Health Case Management
Role of OH Case Managers
Key Concepts of OH Case Management
Success Factors for OH Case Management Programs
Maximizing Workforce Health and Productivity
Models of OH Case Management
The Knowledge Base Required for OH and Disability Case Managers
Return-to-Work Programs
CHAPTER 26 Life Care Planning and Case Management
Introduction
Descriptions of Key Terms
Applicability to CMSA'S Standards of Practice
Aims of Life Care Planning
The Process of Life Care Planning
Role of the Case Manager as a Life Care Planner
The Life Care Plan
Development of the Life Care Plan
Components of the Life Care Plan
Medicare Set Asides: a Life Care Planning Specialty
Health and Disability Insurance
CHAPTER 27 Suggested Resources and Readings in Case Management
Introduction
Descriptions of Key Terms
Applicability to CMSA's Standards of Practice
Case Management Standards of Practice
Case Management Textbooks
Case Management Journals
History and Evolution of Case Management
Healthcare Benefits, Payment, and Reimbursement Systems
Case Management Practice Settings and Throughput
Case Management in the Acute Care Setting
Case Management in the Community and Postacute Care Settings
Case Management in the Home Care Setting
Case Management in Palliative and Hospice Care Settings
Case Management in Remote and Rural Care Settings
Case Management and Transitional Care
The Roles, Functions, and Activities of Case Management
The Case Management Process
Transitions of Care and Case Management Practice
Resource and Utilization Management
Case Management and Use of Technology
Case Manager's Role Leadership and Accountability
Certification and Accreditation in Case Management
Professional Development and Academic Programs in Case Management
Ethics and General Case Management Practice
Ethical Use of Case Management Technology
Legal Considerations in Case Management
Use of Effective Case Management Plans
Quality and Outcomes Management in Case Management Practice
Behavioral Health, Substance Use, and Integrated Case Management
Workers' Compensation Case Management
Disability and Occupational Health Case Management
Life Care Planning and Case Management
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CMSA Core Curriculum for Case Management

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