Case Management Infrastructure

According to Dana Carr, MS, BSN, RN, director of case management at Hebrew Hospital Home Inc. in Bronx, NY, case managers in a subacute setting should have or have access to:

- Office space to increase accessibility of the case manager

- Desktop or laptop computer

- Access to equipment including fax machine, photocopier, telephone, pager, e-mail

- Access to continuing education both inside and outside the facility

- Subscriptions to relevant journals

- Business cards and relevant marketing materials that identify the organization’s mission, vision, values, and goals

Role of the case manager in subacute care

- Interface with admitting, nursing, rehabilitative therapy, social work, pharmacy, finance, and quality assurance

- Identify patients and coordinate care

- Participate in the development and implementation of the care plan and the ongoing evaluation of specific skilled interventions

- Ensure that documentation is appropriate

- Attend daily rounds on subacute admissions

- Work with finance and quality assurance to effect appropriate resolutions

- Assist in the coordination of discharge planning by consulting with the patient and family, social worker, managed care organization and others

- Collaborate with the patient’s primary care physician along with the physician at the skilled nursing facility (SNF) in order to provide a smoother transition

- Market the organization’s programs and services

- Act as a liaison between the SNF and other facilities