Areas of Optimal Case Manager Effectiveness

Reducing costs

• Avoiding test/consult delays

• Avoiding prolonged use of IV antibiotics

• Decreasing inappropriate high-cost lab, radiology, pharmacy, and other medical orders

• Avoiding unauthorized treatments

• Expediting discharge process on admission to prevent increased LOS

• Negotiation with payers to maximize patient funds

• Suggesting alternative treatment plans/appropriate level of care

• Monitoring costs

Enhancing quality clinical outcomes

• Synthesizing other disciplines’ assessment findings and completing an expanded assessment of the patient’s and family’s needs on admission

• Teaching patients and families prior to, during, and post-discharge

• Coordinating the multidisciplinary team under the direction of the MD to promote achievement of desired patient outcomes

• Monitoring patients’ progress toward expected outcomes

• Anticipating an emerging problem and acting quickly to manage an evolving clinical picture

• Preventing patient, practitioner, and system variances when possible

• Monitoring, tracking, and analyzing aggregate complex patient population quality data to improve process/outcomes of care

Enhancing patient, family, and provider satisfaction

• Assist patient in understanding treatment choices, alternatives, benefits, and risks

• Orchestrate the "system" for the patient

• Work with health care team to ensure that patient and family are fully informed and in agreement with the plan of care

• Provide 24-hour on-call availability to MD, patient, and health care team

• Establish working relationships with referral sources

• Communicate to other health care providers as appropriate to coordinate patient care

• Discuss patient’s and family’s satisfaction with them, and respond to complaints appropriately

• Monitor, track, and analyze satisfaction data