What is a Case Manager?
Case managers help provide an array of services to help individuals and families cope with complicated situations in the most effective way possible, thereby achieving a better quality of life. They help people to identify their goals, needs, and resources. From that assessment, the case manager and the client—whether an individual or a family—together formulate a plan to meet those goals. The case manager helps clients to find resources and facilitates connection with services. Sometimes she or he advocates on behalf of a client to obtain needed services. The case manager also maintains communication with the client to evaluate whether the plan is effective in meeting the client’s goals.
This sounds good, but I’m not sure about the term case manager. Do case managers really manage people? I don’t want to lose control, and I’m not a case.
Excellent question. A good case manager will work with you to determine what is important to you and what you think would be the most effective way to reach those goals. Case managers don’t manage people—they help people to manage complicated situations. Simply put, they help to keep you, or your loved ones, at the center of services being provided on your behalf.
Care management and care coordination are two other terms sometimes used to describe this work. Different organizations and individuals define these terms in different ways; for example, professionals providing services to older adults often call themselves geriatric care managers. The terms case management and case manager are used in this site for the sake of simplicity, but the information also applies to care management and care coordination.
Where Do Case Managers Work?
Case managers work in a variety of specialties, including health care, mental health care, addictions, long-term care, aging, HIV/AIDS, disabilities, occupational services, child welfare, and immigrant/refugee services. They are employed in the public, nonprofit, and for-profit sectors.
What Kind of Training, Certification, or License Does a Case Manager Need?
Case managers come from a variety of professional backgrounds and disciplines—including social work, nursing, gerontology, to name a few. They need to understand how to both work with individuals and families and navigate complicated service systems. Case Managers are trained to help people in the context of their unique social environments and are distinctly prepared to offer care services. In fact, the social work profession grew out of early case management work in the early 20th century, and social workers have remained active in case management since that time.
Certification is available in case management and specialty areas of practice, such as gerontology. Knowing a case manager is certified can help you to feel confident that you are working with a skilled, well-trained professional. Some workplaces require certification, but others do not.
Should I Consider Case Management Services?
People coping with complex situations—either their own or of someone close to them—such as physical illness, disabilities of any sort, the aging process, emotional or psychological challenges, family problems, addictive behavior, problems with school or work—may benefit from case management services. Seeking help is a sign of strength and may benefit both you and your loved ones.
Who Pays for Case Management Services?
It depends on your situation. Commercial health insurance, Medicare, Medicaid, or Tricare may pay for case management services delivered within some settings, such as hospitals, rehabilitation, or long-term care settings. In nonprofit or government agencies, case management services may be available on a sliding scale basis or even offered free of charge to eligible consumers. On the other hand, geriatric care management is generally not covered by public insurance or commercial health insurance. Some long-term care insurance policies may cover geriatric care management, and some nonprofits or public agencies may offer it on a sliding-scale basis; otherwise, it tends to be a private-pay service.
How Can I Find a Case Manager?
This depends on your situation. If you are hospitalized or dealing with a system such as workers’ compensation, you may be linked automatically with a case manager. Don’t hesitate to ask if you are unsure. Otherwise, your health care provider, school, employee assistance program, or community service agency may be able to refer you. Local departments of aging and disabilities, health, and social services frequently offer case management services or may be able to refer you to case management agencies or professionals.
Case Managers often use CMSA's Case Management Industry Directory to search across thousands of U.S. health care providers in more than 100 categories, such as homecare, rehabilitation, long-term care, disease management & specialty services, psychiatrics & addiction, and more. As a consumer, you can also use this online, searchable guide to identify independent case managers and care management organizations to assist you in the management of your health care needs.
Licensed social workers who provide case management services are listed in the National Social Worker Finder. Search by specialty area, such as aging; then click on an individual provider from the listing and look for case management under theoretical approach.
Regardless of whether you personally select a case manager or are paired with one you did not choose, it is essential that you feel comfortable with her or his approach. Don’t be afraid to assert your needs, perceptions, and goals. Case management should always involve, and directly benefit, you or your loved ones.
Transitions of Care: Why is this Important to Me?
This is an important topic receiving increased attention in the media. A transition of care takes place when people move between care settings—such as when a person leaves the hospital and returns home or goes to a rehabilitation facility—or care providers (such as physicians and other members of the care team, or agencies involved with the same client or family). Care transitions also occur when a person’s condition or situation changes. For example, a person with a serious physical or mental illness may have a relapse, or a child may leave a foster home and return to her or his family. Lack of coordination during care transitions is, unfortunately, quite frequent and can be disastrous for everyone involved. Failure to transfer important information and medication errors are two examples of common problems that occur during care transitions.
Case managers are integral to successful transitions of care. They help to facilitate communication among everyone involved, including you and your loved ones.
Published from the Case Management Society of North America website, July 2014