Foundations of Case Management

A Practical Guide for RNs Transitioning from Nurse to Case Manager

By: Deanna Cooper Gillingham RN, CCM, FCM

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Foundations of Case Management

A Practical Guide for RNs Transitioning from Nurse to Case Manager

By: Deanna Cooper Gillingham RN, CCM, FCM

Foundations of Case Management is the ultimate resource for the nurse who would like to build on the knowledge and experience they have gained, and transfer those skills to a new career in case management.

It starts by explaining what case management is and the necessary skills, qualities, and traits of the case manager. Next, the reader is able to identify the areas of nursing expertise that are transferable to case management. And finally, they acquire new knowledge and skills that are necessary to succeed in case management.

As an Amazon Associate, we earn from a small portion of qualifying purchases, which does not affect your price.

Book content

Part 1: Introduction to Case Management

Chapter 1: Definition, Philosophy, and Goals of Case Management

Chapter 2: The Case Manager’s Roles, Functions, and Activities

Chapter 3: Case Management Models

Chapter 4: Required Skills and Qualities of the Case Manager

Part 2: The Case Management Process

Chapter 5: Introduction to the Case Management Process

Chapter 6: Step One of the Case Management Process: Client Identification, Selection, and Engagement for Case Management Services

Chapter 7: Step Two of the Case Management Process: Comprehensive Assessment and Opportunity Identification

Chapter 8: Planning

Chapter 9: Implementation and Coordination of the Case Management Plan of Care

Chapter 10: Monitoring and Evaluation

Chapter 11: Closure of Case Management Services

Part 3: Ethical, Legal, and Practice Standards

Chapter 12: Standards of Practice

Chapter 13: Case Management Ethics

Chapter 14: Privacy and Confidentiality

Chapter 15: Legal and Regulatory Requirements

Chapter 16: Healthcare and Disability-Related Legislation

Part 4: Principles of Case Management Practice

Chapter 17: Advocacy

Chapter 18: Self-Care Management, Self-Advocacy, and Client Adherence

Chapter 19: Clinical Pathways, Standards of Care, and Practice Guidelines

Part 5: Utilization Management and Review

Chapter 20: Principles and Process

Chapter 21: The Utilization Management Process

Chapter 22: Identifying Acuity or Severity Levels

Part 6: Care Delivery

Chapter 23: Levels of Care and Care Settings

Chapter 24: Transition of Care

Chapter 25: End-of-Life Issues

Chapter 26: Management of Acute and Chronic Illness and Disability

Chapter 27: Management of Clients with Multiple Chronic Illnesses

Part 7: Rehabilitation

Chapter 28: Rehabilitation Service Delivery Systems

Chapter 29: Assessment of Physical Functioning

Chapter 30: Disability and Work-Related Injury Concepts

Part 8: Psychosocial Concepts and Support Systems

Chapter 31: Social Determinants of Health

Chapter 32: Cultural, Spiritual, and Religious Factors

Chapter 33: Behavioral Change Theories and Stages

Chapter 34: Psychosocial Aspects of Chronic Illness and Disability

Chapter 35: Family Dynamics

Chapter 36: Abuse and Neglect

Chapter 37: Behavioral Health Concepts

Chapter 38: Crisis Intervention Strategies

Chapter 39: Support Programs

Part 9: Communication

Chapter 40: Interpersonal Communication

Chapter 41: Questions

Chapter 42: Communication Methods Used by Today’s Case Managers

Chapter 43: Conflict Resolution Strategies and Negotiation Techniques

Chapter 44: Documentation and Reporting

Part 10: Quality and Outcomes Measurements

Chapter 45: The Case for Quality

Chapter 46: Reimbursement Related Outcomes

Chapter 47: Accreditation Bodies, Their Standards, and Requirements

Chapter 48: Measuring and Reporting the Value Your Case Management Program Brings

Part 11: Reimbursement Methods and Managed Care Principles

Chapter 49: Learning the Language

Chapter 50: Private Benefit Programs

Chapter 51: Public/Government Benefits Programs

Chapter 52: Disability

Chapter 53: Additional Financial Resources

A Note From the Author

It seems like not that long ago, I was transitioning from a more traditional nursing role to case management. I remember the nervousness and uncertainty I felt taking on this new role when I really didn’t understand what case managers did.

I also remember reading books about case management that left me feeling more confused and uncertain. I felt like I was back in school and entered the class late. They were using terminology I didn’t fully understand and discussing concepts that were foreign to me. I realized that the foundations of case management were missing.

With some great mentoring, I was able to fumble my way through my first year as a case manager (thank you Tammy Blachura, Marty Pressly-Turner, Brenda El Dada, and the Lunch Bunch). It took six months before I was finally able to explain the role of a case manager. Six months! I was told this was normal. I can still remember thinking there has got to be a better way.

Fast forward years later and there still isn’t a better way. I decided to create what was missing: the book I wanted when I started in this specialty. The book would explain how to take the knowledge and skills you have acquired as a nurse to successfully transition into case management. The book teaches what case management is and how to practice case management with excellence.

Like my previous book CCM Certification Made Easy: Your Guide to Passing the Certified Case Manager Exam, this book contains no filler or fluff, just what you need to know to successfully begin working as a case manager. It is presented in a way that is easy to read and understand. In addition to learning the foundations of case management, it will serve as an indispensable resource for years to come.

As an Amazon Associate, we earn from a small portion of qualifying purchases, which does not affect your price.

Deanna Cooper Gillingham RN, CCM, FCM is a bestselling author and case management leader. She has over a quarter-century of extensive, award-winning, clinical and case management experience including complex case management, transplant case management, Med Surg, Dialysis, Oncology, Hospice, SICU, LDRP, L&D, and Ambulatory Care.

Deanna is passionate about developing the case management workforce. As co-founder and CEO of the Case Management Institute, she is dedicated to decreasing barriers to entry into the profession and developing case managers into leaders. She is also the leader and co-founder of the Case Managers Community, a Facebook group of over 18,000 committed case managers.

Deanna has developed several courses for nurses and case managers including Foundations of Case Management, Utilization Management, CCM Exam Prep, and Study Strategies for the CCM Exam. She is the author of the #1 Best Seller – CCM Certification Made Easy: Your Guide to Passing the Certified Case Manager Exam, currently in its 3rd edition and the go-to resource for CCM certification preparation.

She is currently living her dream life in Puerto Aventuras, Mexico. From there she is writing her next book or coaching lifestyle entrepreneurs from her patio overlooking the beautiful Caribbean Sea. Unless that is, she is traveling the world with her friends and family.

Editorial review Rebecca Perez, MSN RN CCM Sr. Manager of Education and Strategic Partnerships Parthenon Management Group/CMSA

The practice of case management is finally becoming recognized as essential to health care delivery. The COVID-19 Pandemic brought case management’s value to light more than any other health event in recent years. The Pandemic may have permanently changed how care is delivered and the need for safe and effective care coordination and transitions has become even more important. The field of case management is expected to grow and to support that growth, instruction to foster skilled and competent case managers is essential. Deanna’s course is the perfect option for the individual with no knowledge or exposure to the function of case manager. “Foundations of Case Management” is a comprehensive introduction to the world of care coordination, advocacy, and transition management that most health care professionals only observe in other clinical roles. This course will well prepare the individual to begin their journey as a case manager.

Editorial review. Barbara Buono Kuritz B.S. RN LHCA CCM Case Manager Consultant

Foundations in Case Management by Deanna Cooper Gillingham is a must-read for those that want to transition from traditional nursing to case management but aren’t quite sure how.

This self-study book has an easy-to-understand approach that includes:

Introduction to Case Management
The Case Management Process
Ethical Legal, and Practice Standards
Principles of Case Management Practices
Utilization Management Review
Care Delivery
Rehabilitation
Psychosocial Concepts and Support Systems
Communication
Quality and Outcomes Measurements
Reimbursement Methods and Managed Care Principles
Definitions and Abbreviations

The book is meant to give nurses an understanding of the practice, so they know what they are getting into before making the change. The book also helps nurses know the various settings where case managers work so they can choose the area of practice that meets their expertise.

It is comprehensive without engulfing the reader with extensive details about each topic.

Instead, it gently guides the reader into a discovery about case management. The book has thought provoking questions and case studies positioned along the way to help the reader self-assess their skills and competency level required for case management.

I found Foundations in Case Management an encouraging pathway for those that want to transition from nursing into the rewarding field of case management as well as a vital resource for new case managers, managers, educators, and employers.

As an Amazon Associate we earn from a small portion on qualifying purchases which does not affect your price.