THE CASE MANAGER: ROLE AND PRACTICE
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OVERVIEW: this online course is designed for case managers who have achieved certification and are practicing currently. This is a comprehensive course that fully examines the role of the contemporary case manager within many varied practice settings. Students will explore and study a wide variety of materials that relate to legal and ethical issues in case management, the case management process, financial issues in case management, administration and management of case management programs, as well as cultural and behavioral health issues. Many excellent case studies are presented for review and facilitation of practical learning. Upon successful completion of this course, students earn 60 hours of continuing education contact hours toward Fellowship status recertification. Course Code: CM 400
Instructor/Course Author: Dominick L. Flarey, Ph.D, MBA, RN-BC, FACHE
Link to Resume
TEXTBOOKS: There is one (1) required textbook for this course. The Case Manager's Handbook, 3rd edition. By: Catherine Mullahy, RN,CCM. Boston; Jones and Barlett Publishers;2004. ISBN #: 0-7637-3188-9
You are required to order your own copy of the textbook. Please be sure to order your book as soon as possible so that you can begin your course of study. Note: please be sure to purchase the third (3rd) edition of this book.
AIHCP Online Bookstore: AIHCP provides an online bookstore stocked with all of the required textbooks, and/or materials required for its CE courses. To purchase this book online, click the access store link, go to the table of categories, right upper hand corner, and click on Case Management. Access AIHCP Store: click here
TIME FRAME: You are allotted two years from the date of enrollment, to complete this course. There are no set time-frames, other than the two year allotted time.
BOARD APPROVALS: AIHCP is an approved provider of continuing education by the Florida Board of Nursing and the District of Columbia Board of Nursing. CE Provider # 50-11975. The American Institute of Health Care Professionals, Inc. is a licensed Continuing Education Provider in the State of California, Board of Registered Nursing, Provider # CEP 15595. Access information
Online Classroom Resouces and Tools
* Message Boards: each specialty program has an area to "post" on the message board. Students may post messages at anytime. Posting allows students to converse with those in the same specialty practice and to discuss issues/course content etc. Instructions for posting are provided in the online classrooms.
* Chat Rooms: each specialty has it's own unique "chat room." Inside of the classroom there is a schedule for "chat time" with students in your specific specialty practice. Participating in "chats" is voluntary. The chat sessions are used as means for students to come together and discuss course content or anything related to the courses and/or certification specialty.
* Examination Access: there is link to take you right to the online examination program where you can print out your examination and work with it. All examinations are formatted as "open book" tests. When you are ready, you can access the exam program at anytime and click in your responses to the questions. Full information is provided in the online classrooms.
* Student Resource Center: there is a link for access to a web page "Student Resource Center." The Resource Center provides for easy access to all of our policies/procedures and additional information regarding applying for certification. We also have many links to many outside reference sites, such as online libraries that you may freely access.
* Online Evaluation: there is a link in the classroom where you may access the course evaluation. All students completing a course, must, without exception, complete the course evaluation.
* Faculty Access Information: you will have access to your instructor's online resume/biography, as well as your instructor's specific contact information.
* Additional Learning Materials: some faculty have prepared additional "readings" and /or brief lecture notes to enhance your experience. All of these are available in the online classrooms.
Blog of the American Academy of Case Management: access here
COURSE OBJECTIVES: Upon completion of this course, you will be able to:
1). Identify case management and the basic role and functions of the case manager.
2). Identify and discuss various roles with in the practice of case management.
3). Discuss and understand "continuum of care."
4). Identify the core components of case management.
5). Discuss the concept of managed health care.
6). Discuss the types of insurance providers and administrators.
7). Discuss stop-loss and reinsurance coverage.
8). Explore specialized and ancillary services offer by insurers.
9). Understand the concept of using "report cards" in health care evaluation.
10). Discuss and understand types of insurance lines and health care benefits.
11.) Identify and discuss self-funded insurance plans.
12.) Define and discuss coordination of benefits.
13.) Define patients' bill of rights, and confidentiality issues in case management.
14.) Identify conduct/disclosure issues in case management.
15). Discuss major legal issues related to case management practice.
16). Identify and discuss legislation that has set health care policy in the US.
17). Identify and discuss the ethical responsibilities of case managers in practice.
18). Identify the codes of conduct governing case management.
19). Discuss the major provisions of HIPAA.
20). Define the elements of strong communications skills.
21). Define documentation requirements for the practice of case management.
22). Identify measures to take to educate employers and payers regarding case management services.
23). Discuss telephonic case management.
24). Discuss concurrent, retrospective and prospective reviews.
25). Understand fee for service contracting and capitation plans.
26) Define and give examples of case management "red flags."
27) Discuss the applications of claims software for case and care management objectives.
28). Explain the case manager's consulting role to claims administrative personnel.
29). Identify and discuss important financial issues related to health care systems today.
30). Discuss aspects of negotiations with providers and payers.
31). Discuss concepts of case management business planning and implementation.
32). Discuss case management credentialing and on-going professional development.
33). Identify and discuss various cultural issues related to case management services.
34). Discuss care delivery issues related to the religious beliefs of different cultures.
35). Identify and discuss all of the contemporary issues today related to death and dying and care and case management systems for the dying.
36). Discuss issues related to integrated health care and future growth areas for case management practice.
37). Identify and discuss home care alternatives used today and the role of case management in home care.
38) Identify and discuss the case management process for managing long-term care clients.
39). Identify and discuss the major issues involved in the case management of AIDS patients.
40). Identify and discuss the concept of "public sector case management."
41.) Review and identify core case management roles and functions from provided case studies.
A brief abstract of content:
1). The case management process and the case manager's role and functions.
2). Insurance providers and administrators.
3). Insurance lines and health benefit plans.
4). Legal & ethical responsibilities of the Case Management Profession.
5). The Health Insurance Portability and Accountability Act.
6). Communications in case management.
7). The case management work format and process.
8). Integrated case management.
9). Working with claims departments.
10). Finance and administrative issues in case management.
11). Quality Assurance and reporting systems.
12). Managing a case management department.
13). Trends and opportunities in case management.
14). Managing home care and long-term care.
15). Case managing clients with AIDS.
16). Public sector case management.