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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
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.
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.
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.