Definition and Philosophy of Case Management

Definition of Case Management

The practice of case management is a professional and collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual’s health needs. It uses communication and available resources to promote health, quality, and cost-effective outcomes in support of the “Triple Aim,” of improving the experience of care, improving the health of populations, and reducing per capita costs of health care

Philosophy of Case Management

Case management is an area of specialty practice within the health and human services professions. Its underlying premise is that everyone benefits when clients(1) reach their optimum level of wellness, self-management, and functional capability.The stakeholders include the clients being served; their support systems; the health care delivery systems, including the providers of care; the employers; and the various payer sources.

Case management facilitates the achievement of client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation. Based on the needs and values of the client, and in collaboration with all service providers, the case manager links clients with appropriate providers and resources throughout the continuum of health and human services and care settings, while ensuring that the care provided is safe, effective, client-centered, timely, efficient, and equitable. This approach achieves optimum value and desirable outcomes for all stakeholders.

Case management services are optimized best if offered in a climate that allows direct communication among the case manager, the client, the payer, the primary care provider, and other service delivery professionals. The case manager is able to enhance these services by maintaining the client's privacy, confidentiality, health, and safety through advocacy and adherence to ethical, legal, accreditation, certification, and regulatory standards or guidelines.

Certification demonstrates that the case manager possesses the education, skills, knowledge, and experience required to render appropriate services delivered according to sound principles of practice.

(1) Client refers to the recipient of case management services. It includes, but not limited to, consumers, clients, or patients.

Scope of practice overview