Core Skills for Hospital Case Managers

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Core Skills for Hospital Case Managers: A Training Toolkit for Effective Outcomes

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Core Skills for Hospital Case Managers
A Training Toolkit for Effective Outcomes

Toni Cesta, PhD, RN, FAAN; Beverly Cunningham, MS, RN

Finally—an affordable, effective, and consistent training program for your hospital case managers.

This one-of-a-kind guide to fundamental case management responsibilities is a necessary reference tool for every hospital case management department. This resource is designed to give case management directors and hospital leaders the tools they need to build and strengthen the basic and advanced skills their case management staff needs to succeed.

Core Skills for Hospital Case Managers is an orientation and training manual for nurses transitioning into case management, an easy-to-read reference guide for new case managers, and a source of inspiration, tools, and resources for seasoned professionals.

With a flexible format, this book and CD-ROM offer practical information and customizable tools to develop and maintain a wide variety of care management skills.

Table of contents

Chapter 1: Hospital Case Management 101
Chapter 2: Case Manager Role
Chapter 3: Roles, Functions, and Caseloads
Chapter 4: The Case Management Process
Chapter 5: The Case Manager’s Role in Transitional and Discharge Planning
Chapter 6: Utilization Management
Chapter 7: Managing Long Length of Stay Patients
Chapter 8: Denials: Prevention and Appeals Strategies
Chapter 9: Reimbursement
Chapter 10: The Role of the Case Manager in Patient Flow
Chapter 11: Measuring Success: Strategic Outcome Measures
Chapter 12: Dealing with the Uninsured and Underinsured
Chapter 13: Working with Multidisciplinary Teams
Chapter 14: Crucial Communication and Conflict Resolution


Meet the authors

Beverly Cunningham, MS, RN, is vice president of clinical performance improvement at Medical City Dallas Hospital, where she is responsible for case management, quality, health information management, and patient access. Through her consulting, she directs hospitals, physician groups, and other healthcare facilities to redesign delivery systems focusing on case management implementation through a focus on improved clinical and financial outcomes.

Toni Cesta, PhD, RN, FAAN, is a partner and consultant for Case Manager Concepts, LLC, in Dallas, TX. She has been a national and international leader in the field of case management for 20 years and has authored seven books on the subject.

Faculty Disclosure Statement:

Faculty disclosure statement: HCPro Inc. has confirmed that none of the faculty/presenters or contributors have any relevant financial relationships to disclose related to the content of this educational activity.

Learning objectives:

  • Discuss the evolution of hospital case management
  • Explain the different models of hospital case management
  • Determine the various goals of hospital case management
  • Examine the various roles of case management
  • Discuss the variety of functions performed by case managers
  • Discuss the scope of the case manager position
  • Examine staffing ratios in various models
  • List the steps in the case management process
  • Determine the role of case managers in documentation
  • Examine case managers' role in discharge planning List the factors that influence the discharge planning process
  • Determine strategies for improving discharge planning
  • Discuss how hospital reimbursement affects utilization management (UM)
  • List the stages of UM coordination
  • Determine the affect of outside influences on UM
  • Evaluate different payers' regulations regarding UM
  • Examine case management's role in length of stay (LOS)
  • Evaluate strategies for managing patients with long LOS
  • Identify data used to track and trend LOS
  • Evaluate the reasons behind denials Discuss case management's role in preventing denials
  • Examine case management's roles in reversing denials
  • Examine case management's role in reimbursement
  • Determine strategies for effective case management related to reimbursement
  • Evaluate case management's role in patient flow
  • Discuss demand and capacity management
  • Identify strategies for managing patient flow
  • Identify measurable case management outcomes
  • Explain how case managers can track quality outcome metrics
  • Discuss other metrics case management departments can track and trend
  • Examine ways to create a case management report card
  • Discuss the unfunded or underfunded patient populations
  • Describe the role of the ED case manager with unfunded or underfunded patient populations
  • Evaluate strategies for dealing with unfunded or underfunded patient populations
  • Examine strategies for successfully working with multidisciplinary teams
  • Describe sources of conflict with which case managers frequently come in contact
  • Discuss strategies for reducing conflict

Intended audience

Staff nurses, charge nurses, staff educators, staff development specialists, directors of education, nurse managers, and nurse leaders

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Published: June 2009