Home About the Consultant About Case Management Area Served Services Referral Form		Catastrophic & Rehabilitation Management, Inc.
			1740 44th Ste 226 Grand Rapids, MI  49519 616.531.4040 Fax 616.531.4070 Toll Free 800.531.9634 Email:  cbs@catastrophicrehabmgt.com

About Case Management

Case Management is the process of planning, organizing, coordinating, and monitoring the services and resources needed to respond to an individual's healthcare needs for provision of quality and cost effective case resolution.  The goal of case management is the provision of quality cost effective healthcare services.

THIS PROCESS INCLUDES:

• Timely identification of individuals, ideally at the onset of an injury or illness.

• Referral to a qualified rehabilitation nurse case manager with a high level of expertise in the area(s) of health care.

• Assessment by the case manager to determine the individual's strengths, challenges, prognosis, functional status, goals, and needs for specific services and resources.

• Development of a plan that identifies short and long term goals, involving the individual, support systems, and interdisciplinary collaboration.

• Identification, procurement, and coordination of services and resources to implement the plan.

• Provision for ongoing evaluation of the individual's progress on the plan as well as of the effectiveness and appropriateness of the services provided throughout the entire spectrum of care.

• Advocacy for the most appropriate cost effective services to assure quality of care and attainment of appropriate goals.

• Promotion of the individual's self advocacy skills to achieve maximum self sufficiency and maximum medical improvement.

ROLE DESCRIPTION OF THE REHABILITATION NURSE CASE MANAGER:
The rehabilitation nurse case manager uses the principles of rehabilitation nursing as defined within the established scope of rehabilitation nursing practice and standards developed by ARN and ANA

The Functions of the Rehabilitation Nurse Case Manager are:

1. Obtains necessary authorizations.

2. Reviews and analyzes referral information.

3. Consults with the individual, health providers, employers, family, legal representatives, and claims/insurance personnel.

4. Assesses the individual's personal and medical history, current status, diagnosis, prognosis, current treatment plan, and care provider's level of expertise.

5. Assesses the individual's learning needs related to the medical diagnosis, prognosis, treatment providers, treatment options, financial resources, psychosocial adjustment and coping mechanisms, and vocational rehabilitation requirements and potential.

6. Assesses the family knowledge base, health status, expectations, and the potential for or actuality of a family member acting as the primary caregiver if necessary.

Data Analysis & Formulation of Nursing Diagnosis

1. Identifies any temporary or permanent alterations in function that have resulted from the injury or illness.

2. Identifies potential challenges or complications in physiological and/or psychosocial function.

3. Identifies potential difficulties in community reintegration where appropriate.

4. Identifies the learning needs of the individual and significant others.

Establishment of Goals & Plan of Care

1. Establishes realistic goals to achieve optimal outcomes for the individual.

2. Assists the individual and family in identifying the variables that may influence the accomplishment of goals.

3. Develops a comprehensive plan that includes preventative treatment measures and identifies alternatives for the individual's treatment when appropriate.

4. Establishes target dates for achievement of goals.

Implementation

1. Uses rehabilitation principles to promote optimal outcomes for the individual.

2. Provides ongoing assessment of the individual, caregiver, and/or family.

3. Coordinates access to accelerated and/or alternative care options.

4. Coordinates access to appropriate government and community programs and resources.

5. Coordinates and evaluates the individual's and family's use of medical equipment, supplies, medications, and the full spectrum of services.

6. Provides instruction to the individual and family based on identified learning needs.

7. Coordinates referrals for instruction or counseling agreeable to the individual and family, based on identified learning needs.

8. Provides education, guidance, and recommendations to the payor regarding alternatives for care and services.

9. Intervenes promptly when necessary to promote optimal functioning and prevention of complications.

10. Facilitates and collaborates timely discharge planning to an alternative level of care.

11. coordinates the discharge plan with providers.

Collaboration

1. Collaborates with the healthcare providers, payors, community agencies, and legal representation to ensure continuity of the individuals care through course of treatment and settings.

2. Promotes effective communication among the individual, healthcare providers, family, and payors.

3. Attends medical appointments when needed.

4. Incorporates recommendations and/or services of interdisciplinary team members in plan of care.

Documentation

1. Provides routine verbal and written documentation of the initial assessment and progress of the individual to the payor and/or appropriate others on a timely, regular basis.

2. Projects costs and needs for the future and provides cost analysis to the payor as appropriate.

Community Reintegration

1. Assists the individual and family in anticipating needs and making plans for reentry to home or an alternative living site.
   a.  Recommends and coordinates home assessment.
   b.  Assists in selecting and arranging for home care, equipment, and services.
   
   -OR-

2. Assists in determining alternate level of care.
   a.  Assists in locating and selecting a site.
   b.  Assesses setting and recommends site modifications needed.
   c.  Assists the individual in anticipating needs and plan for reentry into the community.

3. Provides or arranges assessment by educational or vocational counselors.

4. Assists the individual in planning for reentry to the work environment, school system, and/or keeping prior life style.

5. If competitive employment is not an option assists the individual with identification of community activities and resources and/or volunteer placement.

6. Ensures availability or funding through the payor or other resources.

Evaluation

1. Performs periodic reassessment of the individual response and progress toward treatment goals.

2. Facilitates and participates in conferences that provide ongoing evaluation of interdisciplinary dynamics, goal attainment, and treatment plan revision.

3. Facilitates care closure based on the individual's response, achievement of employment, request of payor.

4. Is mindful of and acts on cost/benefit issues.

Quality Assurance

1. Provides for an evaluation of case management services.

2. Incorporates evaluative data in the provision of ongoing case management services.

3. Adheres to established standards of practice and code of ethics as identified by ARN and ANA.

4. Provides case management services in accordance with CCMC Professional Code for Case Managers.

Minimum Qualifications for Case Managers

• Licensure as a registered nurse.

• A minimum of 2 years of related clinical experience.

• Expertise with the rehabilitation of chronically or catastrophically ill or injured individuals.

• National Certifications such as CRRN, CCM, and related areas.

• Maintenance of continuing education appropriate to case management and renewal of certification.

• Demonstrated accountability and skills in analysis, decision making, time management, and oral and written communication.

• Familiarity with rehabilitation resources, regulation and parameters, of reimbursement.