Best Practice Case Management Roles and Functions: How to Optimize RN and Social Worker Skill Sets

Duration: 60 Minutes
Due to the variety of differences in the definition of case management and roles and functions, there is much confusion in the field as to what case management is and how it is applied. Without a national perspective on this issue, many case management departments are not designed to respond to the challenges of health care reform.
Case Management Roles and Functions
Instructor: Dr. Toni Cesta
Product ID: 504932
RN case managers and social workers need to understand the parameters in which they work based on the standards, definitions, and guidelines of our specialty field. These standards provide you with a frame of reference and a standard of practice that should guide your everyday work with patients and families.

Objectives of the Presentation
  • Discuss the Standards of Practice for case management
  • Describe the roles of the case management professional
  • Understand the key roles and functions of the RN case manager
  • Review the key roles and functions of the social worker
  • Describe how the work of case management is distributed between the disciplines
  • Understand a framework for integrating the two disciplines
Why Should you Attend
In an era of dwindling resources, it is important for all case management staff to understand their roles and functions in the acute care setting in order to practice at the "top of their license". RN case managers and social workers have unique but complimentary skill sets. In order to optimize the resources we each have in our departments, it is critical to understand the differences and similarities between the social worker's roles and functions versus the RN case manager's roles and functions.

Areas Covered
  • Introduction to the Standards of Practice
  • CMSA 2016 definition of case management
  • Statement of Philosophy
  • CMSA's guiding principles for case management
  • Definition of a role
  • Role #1 Patient flow
  • Purpose and functions of patient flow
  • Goals of patient flow
  • Role #2 utilization and resource management
  • Fundamental components of utilization management
  • Intersecting patient flow and utilization management
  • Resource management
  • Role #3 denial management
  • Key functions of denial management
  • Shared roles
  • Role #4 Variance tracking
  • Functions within variance tracking
  • Goals of variance tracking
  • Role #5 Transitional and discharge planning
  • Discharge planning
  • Role #6 Quality Management
  • Quality management and the case manager
  • Role #7 Psychosocial assessment and counseling
  • Social work expertise
  • The social worker referral process
  • Integration of the roles
  • Summary of success
Who will Benefit
  • Directors of Case Management
  • Directors of Social Work
  • RN Case Managers
  • Social Workers
  • Directors of Quality Management
  • Vice Presidents of Nursing
  • Directors of Finance
  • Vice Presidents of Operations
Topic Background
The role of the case manager and social worker is dynamic and constantly changing in response to the changes in health care delivery and reimbursement at the federal, state and local levels. While change remains a constant, there are certain core roles and functions that apply to the work of the social worker and nurse case manager regardless of job setting. In addition, case managers and social workers work within guidelines that provide us with definitions of practice, guiding principles and philosophy statements.
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Instructor Profile:
Toni G. Cesta, Ph.D., RN, FAAN owns and operates Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating case management models in the acute care, emergency department and outpatient settings. Dr. Cesta writes a monthly column called "Case Management Insider" in the Hospital Case Management newsletter in which she shares insights and information on current issues and trends in case management. Dr. Cesta has held positions as Senior Vice President - Operational Efficiency and Capacity Management at Lutheran Medical Center in Brooklyn, New York where she was responsible for case management, social work, discharge planning, utilization management, denial management, bed management, the patient navigator program, the clinical documentation improvement program and systems process improvement. Prior to her position as Senior Vice President at Lutheran Medical Center, Dr. Cesta has held positions as Corporate Vice President for Patient Flow Optimization at the North Shore - Long Island Jewish Health System and Director of Case Management, Saint Vincent's Catholic Medical Centers of New York, in New York City and also designed and implemented a Master's of Nursing in Case Management Program and Post-Master's Certificate Program in Case Management at Pace University in Pleasantville, New York. Dr. Cesta completed seven years as a Commissioner for the Commission for Case Manager Certification.

The author of nine books, and a frequently sought after speaker, lecturer and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management.
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