What Is Medical Case Management?

nurse responsible for medical case management using telephoneMedical Case Management (MCM) is a patient-centered care model that helps clinicians manage patients with chronic issues by coordinating and managing their quality of care. Patients are assigned a case manager who coordinates all aspects of their care, from communication with facilities to providing information and resources about the patient’s illness to all stakeholders.

The Four Phases

The four phases of medical case management are screening, assessing, risk reduction, and planning.

Phase 1: Screening

The screening phase involves identifying patients needing assistance with their medical care. It may include reviewing patient information to determine if the patient is eligible for case management services, assessing their health condition, and determining whether any preventive measures are needed.

Phase 2: Assessing

The assessing phase of medical case management is evaluating a patient’s medical condition and developing a plan of care with the patient’s doctor. Patients and their doctors will discuss symptoms and desirable outcomes during this stage. Once the assessment has been completed, patients will be assigned to one of three case management categories: acute care (short-term), intermediate care (medium-term), or long-term care.

Acute care patients will receive priority and should be seen as soon as possible. Options may include medication, surgery, or physical therapy. Acute care patients are usually discharged within a few days of hospital admission.

Intermediate care patients are generally not hospitalized but may need help with daily activities such as bathing and eating. They will likely stay in the same facility for an extended period and can expect to remain there until their condition improves or they move into long-term care.

Long-term care patients are typically elderly and may require around-the-clock care. These patients will usually be admitted to a facility and then transferred to a long-term care home or specialized residence as their condition improves or worsens.

Phase 3: Risk Reduction

The risk reduction phase of medical case management is designed to help patients with chronic issues manage their health and prevent future episodes of illness. The goal is to reduce the patient’s overall exposure to risks, such as developing new infections or exacerbating existing conditions.

Patients receive regular checkups for any existing conditions during the risk reduction phase. They may also be prescribed preventive medications or therapies, such as vaccines or antibiotics, that can help lower their chances of getting sick. In some cases, patients may also be referred for specialized care, such as physical or speech therapy.

doctor examining a patient during a routine checkup

Phase 4: Planning

The planning phase of medical case management is an essential step in the process. It helps to identify the patient’s needs, develop a care plan, and coordinate with other healthcare providers. During this phase, patients and their families are often interviewed to gather information about their health history and current condition. The data is then used to create a plan that best meets the patient’s needs.

It may also require direct communication with insurance companies and government agencies. All of these entities have specific guidelines that must be followed to receive reimbursement. The planning phase can take a lot of time and effort, but it is essential for ensuring that patients receive the most effective outcomes.

Medical Case Management Education

A medical case manager typically has a bachelor’s degree in nursing, social work, or another related field. Case manager certification is not normally required, but some case management programs offer certification as an added benefit. The most important qualification for a medical case manager is the ability to empathize with the patient and a close family member.

Case Management Skills

A medical case manager is a professional who helps patients with their healthcare needs by managing their communication with doctors and other healthcare professionals, organizing and arranging appointments, tracking patient progress, and helping to coordinate care. They may also be involved in research projects or patient advocacy.

In addition, a medical case manager may need communication, organization, patient care, and research skills. They should be able to handle multiple tasks simultaneously with attention to detail and a keen eye for potential problems. A good case manager also has excellent problem-solving skills and can empathize with patients.

On-The-Job Work Experience

Medical case managers gain experience working with patients or their families in a patient care setting. They may also work with patients in research studies or as a team developing new therapies. Some medical case managers may also work with patients in a clinical research setting.

They help patients participate in studies by providing support and advice, helping to keep track of study medications and results, and arranging patient visits to the research center.

Case Management Certifications

Many medical case management programs also require additional certification, such as the National Association of Social Workers (NASW) or Certified Case Manager (CCM) credential.

National Association of Social Workers (NASW)

The NASW certification is a professional designation given to those who meet specific requirements and have completed an accredited program. It can help them find employment in mental health, substance abuse, and specific services.

The NASW certification process includes completing an accredited program, passing a national exam, and registering with the NASW. Candidates must also have at least three years of experience working in social work settings before applying for certification.

Certified Case Manager (CCM)

A Certified Case Manager has undergone rigorous training and certification in the case management process. They can provide leadership and skills to help manage cases of individuals with mental illness, substance use, or other chronic conditions.

They are often the first point of contact for individuals with mental illness and can help them access necessary services and support systems. They also coordinate cases with families, caregivers, patients, and other medical professionals and may work with other agencies or nonprofit organizations to provide case management services.

Case Management vs. Care Management

patient meeting with a team of healthcare providersMedical Case Management is a process that helps individuals with chronic illnesses or disabilities to receive care coordination from multiple service providers. Case management also provides client-centered information about their condition, available options, and resources for managing their health care.

Medical Care Management is a type of patient-centered communication service used by hospitals to coordinate patient care across different settings (e.g., inpatient wards, clinics, and home health services).

Care management facilitates communication among patients’ clinicians, families/caregivers, support staff members, and administrative personnel within an institution so that patients can be informed about their care, receive assistance with managing their health care, and be connected to available resources that can help them live healthier lives.

Benefits to Patients and Family

The medical case management process has been shown to improve patient outcomes by reducing the number of unnecessary visits and hospitalizations, enhancing communication between patients and appropriate providers, and providing patients with personalized information.

BioScan can help identify any potential medical issues a patient may be experiencing and provide information to the medical case manager about the patient’s overall health. The data can help make decisions about support options for the patient and may also lead to additional tests being recommended.


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