Happy National Case Management Week! (Video)

I’m re-posting this classic blog in honor of National Case Management week, October 8th-14th!  Please enjoy the video version as well, introduced by the author.

CareNational specializes in the Medical Management segment of healthcare, meaning four primary areas: Case Management, Utilization Management, Quality Management, and Reimbursement Management. We pride ourselves in our expertise in these areas, as we are able to provide our clients and candidates with an informed perspective and truly consultative approach. However, while we are definitively more knowledgeable than other generalized staffing firms and recruiting agencies, we do not physically perform these tasks nor do we directly oversee these departments, so we need your help.

In Shakespeare’s Romeo & Juliet (Act II, Scene II) Juliet famously asks Romeo: “What’s in a name? That which we call a rose by any other name would smell as sweet.”

Operating coast to coast, and working with both various types of payer and provider organizations, we have encountered a plethora of different terminology and titles for what are essentially comparable departments, functions, and individual roles. Some, such as ‘Licensed Vocational Nurse’ vs ‘Licensed Practical Nurse’ vary state to state, while other terms, such as ‘Medical Management’ vs ‘Healthcare Services’, seem to vary based on organizational preferences. We wanted to look at each of our 4 niche segments and discuss the various titles, terms, and subsets of the discipline to see what you, the reader, had encountered in your education and experience.

The first of our core focus areas is Case Management, and it is arguably our strongest niche out of the four. CareNational is an active member of both national and local chapters of the Case Management Society of America (CMSA), and if you visit a prior blog of ours about specialized recruiting, you can see that job opportunities for Case Managers accounted for roughly half of all our current openings!

“Case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes.” 
– CMSA Definition of Case Management

Why are there so many different terms for what is essentially the same function? Clearly ‘Case Management’ is the most common term, but ‘Care Management’ seems to be interchangeable, depending on the organization. On the other hand, we have also seen ‘Care Management’ used when referring to direct acute patient care, and not referencing the collaborating coordination process referenced in the definition. To a lesser extent, the terms ‘Case Coordination’ or ’Care Coordination’ have been used as synonyms to ‘Case Management’, but more often these Coordinator titles refer to a non-clinical person assisting with mostly administrative functions in order to support clinical Case Managers. There is also ‘Complex Case Management’, sometimes called ‘High Risk Case Management’, usually refers to managing the cases of patients or members that have two or more co-morbidities.

To add a little more confusion to the mix, there are a few specialized subsets of the discipline. ‘Disease Management’ nurses generally specialize in chronic conditions, such as diabetes or asthma, rather than more short term, acute conditions. These nurses are sometimes called ‘Health Coaches’ as they have a focus on overall wellness and health education. Occasionally ‘Health Coach’ refers not to a chronic condition but to the Case Management of an individual recovering from an acute condition in a post-discharge setting. Depending on the facility, ‘Discharge Planning’ may be a function of the nurse Case Manager, or it might refer to a specialized role that ensures patients and family members have all the health and resource information they need to reduce the risk of readmissions. Other times a ‘Wellness Nurse’ or ‘Health Coach’ specializes in preventative care and measures for an otherwise healthy population of health plan members. This reduces overall costs by ensuring that regular check-ups and tests are done before a situation escalates to an acute condition requiring hospitalization.

We could continue to muddle these matters by discussing the cross-over between Utilization Management and Case Management, generally due mostly to organizational structure and size. However that will be discussed in detail in the next “What’s in a Name” segment, focusing on Utilization Management and Utilization Review.

As stated initially, CareNational specializes in recruitment and career search consultation in these specialized areas, but we do not perform these functions ourselves. So how did we do? Did we accurately identify the most common job titles related to these functions and duties? Did we miss anything or get anything wrong? Please let us know! What titles does your organization use? What terms have you seen throughout your career? We want to hear from the experts: that’s you!

Please comment below with your thoughts and experiences. You can also contact us via email at info@carenational.com or call us toll free at 800-974-4828.