Medical Case Managers Role

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According to Davila (n.d.), nurses work behind the scenes working to maximize the quality and cost effective of healthcare services. Their purpose is to conduct reviews and audits to ensure patients are receiving the proper care. This will help avert burden in the health care system such as redundant medical procedures or ineffective treatments that prolongs the client’s hospital stay. There are five ways that case managers can improve the hospital’s performance: improving the outcomes, reduction of readmissions, eliminate avoidable day, enhancing claims management and boosting the core competencies (Fink-Samnick, Owen, & Rasmussen, 2013). Case managers play a vital role in the health care systems which are considered as the face of client …show more content…
These services ensure timely and coordinated access to medically appropriate levels of health and support services and continuity of care through ongoing assessment of the client’s and other key family members’ needs and personal support systems. Medical case managers work in conjunction with health care providers by ensuring all clients are case conferenced during the medical rounds at a minimum of twice per year. Case manager’s implements the medical treatment plan by giving counseling on medications, medical appointments and other treatment pertaining to the client’s condition. Their purpose is to conduct the initial pre-screening of clients by determining the eligibility for medical services and the appropriateness of case management services. A complete client assessment and reassessment is used as a standard measure for the system of care. A comprehensive care plan is developed jointly with the client who includes short and long term goals that focuses on attaining, maintaining and accomplishing positive health …show more content…
Case managers play a vital role in the health care systems which are considered as the face of client care and are usually registered nurses. As a client advocate medical case manager, one must assist the coordination of the use of clinical resources accessible to the client, such as referrals to other specialties. The coordination and follow-up of medical treatments are key components of medical case management. Case management program will become the medical program necessary for the future for hospitals due to several factors such as cost saving and quality care improvements. A case manager serves as a liaison between the client and other organizations. Case managers are considered the “gatekeepers” in the health care services. Case management has it’s flaws and so do many programs, but there are great benefits in this

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