What Is Case Management? Definition, Process, and Models

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Case management is all about connecting patients with health care providers, designing treatment plans, and ensuring the timely completion of all tasks. Learn more about this project-oriented health care profession.

[Featured Image]:  A case manager, wearing a blue uniform and a blue head covering, is sitting in front of three computer screens, looking at charts.

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.

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Learn more about case management and its process and explore different case management models. Then, explore courses you can take to understand case management better. 

What is the role of 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. 

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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. Learn more about what you can expect from the case management process and the skills you’ll need to do it, and find an example of case management in action.  

What are the steps of case management?

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: As a case manager, you’d review a client’s medical records, medical history, and current financial, living, and social support situation to understand the client’s needs and current circumstances. 

2. Assessment: Next, you would conduct more in-depth research and meet with the client to assess their medical condition and circumstances. You might assess the client's health insurance, support systems, and treatment response history. 

3. Risk evaluation: In this stage, you would evaluate the client's risk for particular ailments. Common factors assessed include existing medical conditions, blood pressure, mental health, and finances. 

4. Planning: During the planning stage, you would create a plan of care for your 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, you help the client implement it by ensuring they attend appointments and educating them about health care-related issues.

6. Follow-up: During the follow-up stage, you would evaluate how the client progresses through their treatment plan by speaking with them, their health care providers, and their personal support network. If needed, you might advise changing the treatment plan.

7. Evaluating outcomes: Finally, you would review the entire case and evaluate its outcomes, such as the client's well-being, finances, and whether they received appropriate care.

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Top skills for case manager

Being a case manager requires both technical health care knowledge and strong interpersonal skills. Common skills to develop as a case manager 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 

What is an example of case management?

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

Case management models

Three primary case management models exist in health care. While they are all oriented toward getting clients the care they need, each has its unique emphasis. Depending on your client's needs, you might use a combination of these models.

Brokerage case management model 

In the brokerage case management model, you would assess a client’s needs and then act as a broker that connects them with the relevant resources, services, and medical professionals. Typically, you will 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 taking on the role of a therapist or counselor as a case manager. A clinical care provider assigns your specific role. Once assigned, you will work directly with the client in a clinical capacity, providing care and 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 centers on 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 hold clients back. Though initially developed for those with severe mental health problems, this model is also suitable for a variety of clients with unique needs. 

Learn more about case management 

Case management is the systematic process of planning, delivering, and monitoring health care services to a patient. 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. 

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