What Is Case Management? Definition, Process, and Models

In health care, case management is a process that connects patients with health care providers, resources, and services. Directed toward ensuring that patients receive the best possible care, case management requires case managers to maneuver different health care systems and collaborate with stakeholders, including patients, medical professionals, and health insurers.

In this article, you will learn more about case management, its process, and explore some different case management models. At the end, you will find more articles and courses you can take to gain a fuller understanding of case management. 

What is a case manager?

A case manager is a certified medical professional who connects patients with health care providers, coordinates appointments and treatment plans, and helps patients meet their optimum level of health.

Nurse case managers, for example, are registered nurses (RN) who use their medical expertise to help patients maneuver the health care system and health insurance to receive appropriate care. 

What is case management?

Case management is a process that involves numerous stages and requires a unique intersection of health care knowledge and interpersonal skills. In this section, you’ll learn more about what you can expect from the case management process, the skills you’ll need to do it, and find an example of case management in action.  

The case management process

Case management is a collaborative process in which a case manager works with clients to ensure they obtain the proper health care in the most cost-effective manner. This is what the process typically looks like: 

1. Screening: The case manager reviews a client’s medical records, medical history, and current financial, living, and social support situation to understand client’s needs and current circumstances. 

2. Assessment: The case manager conducts more in-depth research and meets with the client to assess their medical condition and circumstances. They might assess the client's health insurance, support systems, and treatment response history. 

3. Risk evaluation: In this stage, the case manager evaluates the client's risk for particular ailments. Common factors that are evaluated include existing medical conditions, blood pressure, mental health, and finances. 

4. Planning: The planning stage is when a case manager creates a plan of care for their client, which outlines their health objectives, self-care goals, health care options and services, care schedule, and any relevant resources. 

5. Implementation: Once a plan has been devised, the case manager now helps the client implement it by guiding them in making sure they attend appointments and educating them about health care-related issues.

6. Follow-up: During the follow-up stage, the case manager sees how the client is progressing through their treatment plan by speaking with them, their health care providers, and their personal support network. If needed, the case manager might advise changing the treatment plan.

7. Evaluating outcomes: Finally, the case manager reviews the entire case and evaluates its outcomes, such as the client's well-being, finances, and whether they received appropriate care.

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Case management skills

Being a case manager requires both technical health care knowledge and strong interpersonal skills. Common skills that case managers should possess include: 

• Medical knowledge of a wide variety of ailments

• Knowledge of the health care system, including different medical professionals, medical organizational structures, and health insurance providers 

• Project management and coordination

• Communication 

• Empathy 

• The ability to collaborate with others 

Case management example

An elderly patient who recently suffered a stroke might be assigned a case manager at their hospital to ensure they get the ongoing care they need. In this situation, the case manager would act as a liaison between the patient and their health insurer. They would assess the patient’s current support network, suggest rehabilitation centers, and direct them toward additional resources. Over time, they would monitor the patient’s progress and make sure they attend their medical appointments and take any prescribed medication. 

Case management models

There are three primary case management models used in health care. While they are all oriented toward getting clients the care they need, each has its own unique emphasis. A case manager might use a combination of these models depending on their client’s needs.

Brokerage case management model 

The brokerage case management model involves a case manager assessing a client’s need and then acting as a broker that connects them with the relevant resources, services, and medical professionals. Typically, case managers in this system have little personal contact with the client, acting instead as a liaison to ensure they receive the care they need. This model places less emphasis on monitoring outcomes and more on connecting clients with the medical professionals who will.  

Clinical case management model

The clinical case management model involves a case manager (often a therapist or counselor) assigned by a clinical care provider. The case manager works directly with the client in a clinical capacity, providing care as well as coordinating and developing treatment plans. Such direct collaboration can increase the client’s health outcomes and encourage them to follow their care plan more directly. 

Strengths-based clinical case management model

The strengths-based clinical case management model is oriented around empowering clients and their support networks so they can meet their health goals. In effect, this model encourages psychological and emotional empowerment by reframing internal narratives and social empowerment by changing environmental factors that could be holding clients back. Though initially developed for those with severe mental health problems, this model can be used for a variety of clients with unique needs. 

Learn more about case management 

As you plan your future career as a case manager, you might consider taking a flexible, cost-effective online course to gain critical job skills and deeper insight into the patient experience. The University of Houston’s Value-Based Care Specialization introduces course takers to the fundamentals of value-based care, such as the role of case management and the power of effective communication to improve health outcomes for both patients and health care professionals.