Concepts of case management encompass quality service coordination with a focus to address the needs of clients cost-effectively to achieve desired outcomes (National Association of Social workers [NASW], 2007). The roles and responsibilities of case managers can either occur in a single or multiple health care settings. On the other hand, this can occur when the client goes through the healthcare continuum. The case manager has got many roles and responsibilities in the provision of case management services. This is because case management is a process that involves assessment, planning, coordination of care, facilitation, and evaluation as well as advocacy for services and options that meet the needs of the client (National Association of Social workers [NASW], 2007). This essay will discuss the roles and responsibilities of case managers in the provision of health care.
It’s the responsibility of a case manager to assess his or her clients and establish their health and psychosocial status. Assessments may target clients’ health literacy status and deficits among others. According to Tahan, Huber, and Downey (2009), case management involves comprehensive assessments of clients’ health and psychosocial needs among others. More so, the case manager doesn’t stop at that point. He or she goes ahead to develop a case management plan in liaison with the client, family, and the caregiver. Yoder-Wise (2014) asserts that case managers have an essential role in the provision of care since the screen and assess the client’s needs through the analysis of information, which results in the professional judgment of risks, needs, and strengths.
Thereafter, the case management plans with the client, his or her family, caregivers, payer, and the community as a whole. The plan aims at maximizing health care quality to achieve cost-effective outcomes. Case planning is key in determining the goals and objectives of care (Fairman, Rowe, Hassmiller, & Shalala, 2011). Such involves the identification of strategies to address the emotional, social, and physical needs of the client. Since this is an interactive process, all the stakeholders should play their respective roles under the influence of the case manager. In the whole process of planning, the manager facilitates coordination and communication among members such as the client and care providers to make therapeutic decisions.
Furthermore, the responsibility of educating the client and members of the health care team on numerous matters is the work of case managers. Education dwells on matters like community resources, treatment options available, case management, insurance benefits, and psychosocial concerns (NASW, 2007). The aim of this is to ensure that quality decisions are made on an informed and timely basis. In doing all this, the main role is to implement the case management roles. That is through the provision and or arrangement of case management services with the use of existing resources to meet the planned goals. In doing this, the client communicates with the case manager to ascertain if the needs are being met as planned.
Most cases can fail to advance as intended because of monitoring challenges. It is the responsibility of the case manager to ensure that he or she obtains feedback from the client and care providers to determine if the plan is being executed rightfully as intended or not (Vanderplasschen, Wolf, Rapp, & Broekaert, 2010). The process of monitoring cannot go on its own without evaluation of the strategies being implemented. The case manager is endowed with the responsibility of evaluating whether the laid down goals and objectives have been met or not and if there is a need to change the plan because of the changing needs of the client. In the case that the needs have changed, the case manager goes ahead to facilitate the whole case management process from the beginning.
Finally, the case managers have the role of advocating for the client and the payer to enhance positive outcomes. Tahan, Huber, and Downey (2009) reiterate that when case managers advocate for the client and the payer, the case management outcomes are often positive. In the case of a conflict, the rights and needs of the client are prioritized. Once all the roles and responsibilities are played well, the case manager can close the case at the most appropriate time. That is when the intended goals and objectives have been met and the client’s problems have been solved.
In summary, case management involves assessment of needs, planning and coordination of care, service evaluation, and advocacy to meet the assessed client’s needs. Case managers have roles and responsibilities in assessing the client, planning the case management services with the client and other members, and implementing the plan. Furthermore, case managers have the role to monitor and evaluate the execution of the laid down plans. Importantly, case managers have an immense responsibility in advocating for the rights and needs of both the client and the payer to achieve better outcomes after quality service delivery.
Fairman, J. A., Rowe, J. W., Hassmiller, S., & Shalala, D. E. (2011). Broadening the scope of nursing practice. New England Journal of Medicine, 364(3), 193-196.
National Association of Social workers [NASW] (2007). Standards of Practice for Case Management. Washington, DC: NASW Press.
Tahan, H., Huber, D., & Downey, W. (2009). Case Managers’ Roles and Functions: Commission for Case Manager Certification’s 2004 Research, Part I. Lippincott’s Case Management, 11(1), 4-22.
Vanderplasschen, W., Wolf, J., Rapp, R. C., & Broekaert, E. (2010). Effectiveness of different models of case management for substance abusing populations. Journal of Psychoactive Drugs, 39, 81–95.
Yoder-Wise, P. S. (2014). Leading and managing in nursing. Amsterdam: Elsevier Health Sciences.