Where a court manages the cases which are awaiting hearing by setting time frames within which certain steps must be taken eg: filing of affidavits• Civil Courts
The coordination of the various services needed by vulnerable clients or patients which are offered by different agencies and providers. Important elements include an assessment of client needs, the development of an individualized care plan, the arrangement for provision of services, and subsequent evaluation of the effectiveness of the services provided.
The process by which all medical issues for a single patient are overseen by a single physician or designated health professional. Physician case managers coordinate referrals to consultants, hospital care and ancillary services like home health and physical therapy. Case management is intended to ensure continuity of services and prevent the misutilization of resources.
A systematic, coordinated approach to patient centered care that provides for quality along the continuum, integration of care delivery across many settings, enhancement of the quality of life and encourages education and accountability.
The process by which patients with extensive, complex or serious medical conditions can receive planned treatment that is both cost effective and of high quality. Early intervention and a systematic coordination of care among multiple providers are elements of this approach.
The assessment of an insureds long term care needs and the appropriate recommendations for care, monitoring and follow-up as to the extent and quality of services to be provided.
At many rehabilitation agencies, clients are assigned one person as their "case manager." This person monitors all the different services and needs of the client. The case manager approves the kinds of services a client gets and if the rehabilitation agency will pay for it.
a system in which a specific health department employee is assigned primary responsibility for the patient, systematic regular review of patient progress is conducted, and plans are made to address any barriers to adherence
Case management refers to control of the movement of cases through a court, or a method of managing cases within the litigation process.
the monitoring and coordination of treatment rendered to patients with specific diagnoses or requiring high cost or extensive services.
A cost-containment program designed to identify alternate, less costly methods of treatment for seriously ill patients without sacrificing the quality of care a patient receives. Also known as catastrophic claim management, large claim management, or medical case management.----------[ Back
The linking of a consumer to the service system and coordinating the various system components in order to achieve a successful outcome. The five case management activities are: (1) assessment, (2) planning, (3) linking, (4) monitoring, and (5) advocacy. Case management's primary goal is service provision for the consumer, not management of the system or its resources.
a method of managing the provision of health care to members with catastrophic or high cost medical conditions. The goal is to coordinate the care so as to both improve continuity and quality of care as well as lower costs.
Coordination of short and long-term disability, health care, workers' compensation, ergonomics, and return-to-work programs to improved care delivery, streamline claims administration, and return employees to work.
The provision of a client-centered approach in the delivery of services, designed-- (A) to prepare and coordinate comprehensive employment plans, such as service strategies, for participants to ensure access to necessary workforce investment activities and supportive services, using, where feasible, computer-based technologies; and (B) to provide job and career counseling during program participation and after job placement.
This is a service that links, mobilizes, coordinates, monitors, and reviews services and resources for the consumers of the mental health services.
Client-centered professional level service designed to assist, identify, and obtain services needed.
A standardized method of coordinating services needed by health plan participants. Assesses participant needs and develops a goal-oriented individualized care plan that effectively uses services provided by the participant's insurance plan. Typically used to assist participants with chronic or high cost medical conditions. Generally provided by the insurance carrier, but may be provided by a contracted case management service.
A program that will pay for healthcare services your health plan usually will not cover if those services will help you get well faster or better. For example, a woman goes into premature labor and her doctor recommends a drug that will keep her from delivering the baby. Her health plan would not normally pay for this drug. But under case management, special members of the health plan's staff look at the woman's case. They realize if she were to have her baby early, the baby could risk its life and run up huge medical bills. So they cover the drug.
The activities of a professional with a great deal of knowledge of the services and programs supported by the public MH/DD/SA system who assists individuals in accessing and coordinating services.
An application that manages information and activities around a specific event or "case". Often found in government and insurance. This would include applications that use DCTM for processing claims (also see complaint processing).
A system for assessing, planning treatment for, referring, and following up on patients in order to ensure the provision of comprehensive and continuous service and the coordination of payment and reimbursement for care.
The mechanism for ensuring continuity of care across inpatient and community settings, for access to and co-ordination of the range of services necessary to meet the individual and identified needs of a person within and outside the mental health service.
A utilization management (UM) technique frequently used by third party payors and self-insured employers to monitor and coordinate treatment for specific diagnoses, particularly those involving high-cost or extensive services (e.g., mental health illnesses and chemical dependencies).
A process in which a registered nurse and case management team is assigned to an individual patient to assess, coordinate, monitor, and evaluate the options and services required to meet the patientâ€(tm)s health care needs. Case managers access all available resources to promote quality and cost-effective outcomes.
A quality and utilization management technique usually used for patients with complex cases and who may need expensive care.
Ohio Med. Special intensive medical evaluation of persons with designated illnesses or injuries. These are usually severe and potentially high-cost situations, such as serious head injuries, neonatal cases and back injuries. The goal is to develop medically acceptable, less costly alternate courses of treatment. For example, Case Management may suggest rental of special equipment and provision of full-time nursing care at home in lieu of extended hospitalization.
A client centered service that assists individuals in identifying physical and emotional needs and problems through an interview and assessment process; discussing and developing a plan for services which addresses these needs; arranging and coordinating agreed upon services; and monitoring the quality and effectiveness of the services.
The practice of having a single expert, often a social worker or a nurse, work with the client, family and other professionals involved with the case to plan and coordinate all of the health and social services needed by the client.
Case management refers to a cost control method that directs the insured to the most appropriate duration and type of service. It can also refer to the monitoring of such outcomes.
A process by which an enrollee with a serious, complicated, or chronic health condition is identified by a managed care organization and a plan of treatment is established in order to achieve optimum health in a cost-effective manner.
A process of arranging, negotiating, and coordinating medically appropriate care in a more economical, cost-effective, and coordinated manner during prolonged periods of intensive medical care, including the use of benefit substitution, based on the member's benefit agreement.
techniques used to process cases from one stage of the proceeding to another, such as setting deadlines for discovery or scheduling a series of pretrial conferences. Case management calls for different approaches from one case to the next and is the primary responsibility of judges, assisted by lawyers and clerks' office personnel.
A system of assessing, planning, treating, referring and following up patients to ensure continuity of care through the provision of coordinated and comprehensive services. The system is designed to ensure that care is provided in the most cost-effective settings.
A process in which a patient with specific health care needs is identified and a plan is developed to coordinate health care services to achieve optimum patient health outcomes in a cost-effective manner.
Process of directing an ongoing course of treatment to assure that it occurs in the most appropriate setting and that the best form of service is selected. Often produces alternatives to institutional care that result in better patient outcomes as well as lower costs.
A coordinated set of activities designed to assist a Member in managing with specific health care needs.
coordination of a client/patient's health care services to ensure appropriate, quality care as their health care and social needs change.
A program that assists the member-patient in determining the most-appropriate and cost effective treatment plan. Case management is usually provided to patients who have prolonged expensive or chronic conditions. The program helps determine the treatment location (hospital, other institution or home) and may authorize payment for such care if it is not covered under the member's benefit agreement.
A service that helps people arrange appropriate and available services and supports.
"Case management has been described as a structured and formal process, whereby a facilitator has a clear responsibility to help an individual, in a planned way, to achieve a specified goal. The process must deal with any need or circumstance that impedes the achievement of the goal. To do this, the client is helped to access the full range of available, relevant services" (Kearney, 1994).
An assessment of a policy holder’s needs over the long term – i.e.: care recommendations, as well as follow-ups.
A utilization management technique that focuses on coordinating a number of health care and disability services. Case management includes a standardized, objective assessment of client needs to develop and provide service or a care plan based on these needs.
Service performed by one member of a medical team or organization, usually a primary care physician. The case manager supervises the provisions of medical care for each patient under his/here care. Case management is widely used to ensure the delivery of coordinated and appropriate care. (See Gatekeeper)
A program that assists the patient in determining the most-appropriate and cost effective treatment plan including coordinating and monitoring the care with the ultimate goal of achieving the optimum healthcare outcome.
a process that focuses on coordinating a number of services needed by patients with complex medical conditions. It includes an objective assessment of a patient's needs and develops an individualized care plan, within the scope of benefits, that is based on the needs assessment and is goal oriented. Patients' families may be involved as well. The goal is to provide the best possible management of care.
is a range of services provided to assist and support patients in developing their skills to gain access to needed medical, behavioral health, housing, employment, social, educational, and other services essential to meeting basic human services; linkages and training for patient served in the use of basic community resources; and monitoring of overall service delivery. This service is generally provided by staff whose primary function is case management. 11
Assess needs, create service plans, and coordinate and monitor services and resources. The case manager may operate independently or may be an employee of a public or private agency.
Case management is a service that helps people with disabilities to coordinate all of their services. A Case Manager is the person manages this process.
Clinical coordination and monitoring (by medical professionals such as nurses) of health plan members who have special or complex medical needs to ensure their care needs are met.
(see also Intensive Case Management, Utilization Management): Coordination and monitoring of an individual patient's treatment by a third party, either by a single case manager or a case management team. The goals of case management are to ensure that a patient receives and makes the best use of needed services and adheres to the treatment plan, so that he or she maintains a stable life in the community and avoids costly care, such as inpatient treatment. Case management can occur at the provider level or the payer level.
A process where a covered person with specific healthcare needs is identified and a plan is designed and used to achieve the best patient outcome in the most cost-effective manner.
When a child is diagnosed as having an elevated blood-lead level, medical followup should occur and continue as necessary to ensure the blood-lead level decreases over time. This process is called case management.
The process of having a personâ€(tm)s healthcare needs coordinated by using an ongoing plan.
The process whereby a health care professional supervises the administration of medical or ancillary services to a patient, typically one who has a catastrophic disorder or who is receiving mental health services. Case managers are thought to reduce the costs associated with the care of such patients, who providing high-quality medical services.
A process used to manage and meet specific health care needs to produce favorable outcomes in a cost effective manner. This process is often used to manage medically-complex, high-utilization clients.
A function in the delivery of health care services that insures that patients get effective, efficient, and timely care. Included are assessment of the needs of the patient, assurance of access to and coordination of services, monitoring delivery of the services, and providing reassessment to ensure that the services provided are appropriate to the needs and desires of the patient.
A service provided to an older individual at the direction of the older individual or a family member of the individual. Service is provided by an individual who is trained or experienced in case management.
Monitoring and coordinating of treatment given to patients with specific diagnosis or requiring high-cost or extensive services.
A service that helps people arrange for appropriate services and supports. A case manager coordinates mental health, social work, educational, health, vocational, transportation, advocacy, respite care, and recreational services, as needed. The case manager makes sure that the changing needs of the child and family are met. (This definition does not apply to managed care.)
Facilitating the access of a patient to appropriate medical, rehabilitation and support programs, and coordination of the delivery of services. This role may involve liaison with various professionals and agencies, advocacy on behalf of the patient, and arranging for purchase of services where no appropriate programs are available.
a process enlisted by employers and health insurance companies that result in individuals or groups receiving premium health care and health insurance services.
The task of overseeing an individual patient’s medical and social needs, assuring that any and all necessary services are obtained.
A program in which a case manager (physician, nurse or other healthcare professional) monitors a patient who requires long-term medical care due to a catastrophic illness or injury and works with the patient's attending physician to help improve the continuity, quality and cost efficiency of care.
Case management describes the care and services planned by health care workers.
A process used by a doctor, nurse, or other health professional to manage your health care.
A system requiring that a single individual in the provider organization is responsible for arranging and approving all resources needed under the contract embraced by employers, mental health authorities, and insurance companies to ensure that individuals receive appropriate, reasonable healthcare services.
a process whereby a covered person with specific health care needs is identified and a plan which efficiently utilizes health care resources is designed and implemented to achieve the optimum patient outcome in the most cost-effective manner.
A method of review whereby a covered person's health, catastrophic, chronic or complex health problem or general health is evaluated and a plan of care is developed and implemented which meets that covered person's particular needs.
The process by which all health-related matters of a case are managed by a physician or nurse or designated health professional. Physician case managers coordinate designated components of health care, such as appropriate referral to consultants, specialists, hospitals, ancillary providers and services. Case management is intended to ensure continuity of services and accessibility to overcome rigidity, fragmented services, and the mis-utilization of facilities and resources. It also attempts to match the appropriate intensity of services with the patient¹s needs over time.
Also referred to as 'care coordination' or 'care management', case management is the process of helping an individual or family explore options and services based on a review of a person's or family's needs, then helping the family or individual plan and implement care. A case manager plans, implements, coordinates, monitors and/or evaluates the provision of all the selected services. ( 4-03)
A process and technique to manage the care of specific health care needs (often multiple) in a way that is designed to achieve the optimum patient outcome in the most cost-effective manner.
process whereby covered persons with specific health care needs are identified and a plan designed to efficiently utilize health care resources is formulated and implemented to achieve the optimum patient outcome in the most cost-effective manner.
Management directed toward serious conditions likely to require numerous providers and involve costly care. Case managers handle each case individually, identifying the most cost-effective treatments for extremely resource-intensive conditions, such as accidents, AIDS, cancer, major trauma, prematurity, and strokes.
The management of information between multiple CASE encyclopedias," whether the same or different CASE tools.
A voluntary program of individual planning and care for seriously ill people, with a case or care manager working with patient and physician to ensure that all appropriate care and appliances are provided and paid for, including specific services that may not be covered by the subscriber’s contract.
Case management is a system embraced by employers and insurance companies to ensure that individuals receive appropriate, reasonable health care services.
management of a specific patient's care by a registered nurse or other qualified individual.
The total provision of services to a consumer that addresses the needs of the client to function at his or her best level in the community.
computer applications designed to record all aspects of cases system appearing before the courts. Cautioning a formal method of dealing with young offenders without taking court proceedings. Police officers may caution young offenders instead of charging them if the offence or the circumstances of the offence are not serious. CBO Community-based order.
Case Managers are generally responsible for coordinating long term patient care (heart/kidney disease, transplants, etc.), as well as the care of patients who have been discharged from the hospital to home. They may be employed by the hospital or by a health plan. These individuals are a direct point of contact between the patient and his or her physician.
A method by which a health plan attempts to control costs by directing all of the procedures for care of an individual through a nurse or other health care professional.
A professional service that arranges and coordinates health and/or social services through assessment, service plan development and modification, monitoring, and quality assurance.
A cost-containment process of handling costs of illnesses and injuries by identifying alternate methods of treatment that can make the most efficient and cost effective use of medical resources consistent with desirable results for a patient.
a method of coordinating the provision of healthcare to persons injured in automobile accidents, with the goal of ensuring continuity and quality of care and cost effective outcomes. The Case Manager may be a nurse, social worker psychologist, or physician, preferably with certification in case management.
The monitoring, planning, and coordination or treatment provided to patients with conditions requiring high cost or extensive services.
A method whereby a health plan attempts to ensure efficient, cost-effective, quality delivery of healthcare services by coordinating patient care through a nurse or other qualified healthcare professional.
A form of utilization review used with high-cost cases in which a health care professional monitors and manages treatment and suggests alternatives to lengthy hospital stays. The case manager supervises the administration of medical or ancillary services to patient, typically one who has a catastrophic disorder or is receiving mental health services.
A method of supervising a patient's or group of patients' utilization of services. The supervision typically is performed by a nurse or social worker and often is indicated in cases of catastrophic or chronic disease.
A process of identifying plan members with special health care needs, developing a health-care strategy that meets those needs and coordinating and monitoring the care, with the ultimate goal of achieving the optimum health care outcome in an efficient and cost-effective manner. Also known as large case management (LCM).
A system of coordinating medical services to treat a patient, improve care, and reduce cost. A case manager coordinates health care delivery for patients.
Assignment of a nurse or other professional to assist identified patients through an episode of care. In the context of disease management, the case manager provides education, support and outreach to patients, in some cases including home visits and assistance arranging for needed medical and community services.
An organized process of coordination among a multidisciplinary team to provide a full range of appropriate treatment, rehabilitation and support services to a mentally ill client in a planned, coordinated, efficient and effective manner.
A range of services provided to assist and support people in developing their skills to gain access to needed medical, behavioral health, housing, employment, social, educational, and other services essential to meeting basic human needs; and forming linkages to and training in the use of community resources. Staff dedicated to case management generally provides these services.
A Department-wide system wherein comprehensive case management plans are developed for offenders at initial placement and continue through reduced custody and community supervision. The plans attempt to match the offender with the best resources available for that offender's needs consistent with custody designation and facility placement assignment.
The client advocate aspect of an organized system of coordinative activities developed and administered by the Single County Authority (SCA) to ensure client continuity of service, efficient and effective utilization of available resources, and appropriateness of service to meet the needs of the client. This can include linkages with other social services, housing, and medical assistance
Coordination of services to help meet a patient's health care needs, usually when the patient has a condition which requires multiple services from multiple providers. This term is also used to refer to coordination of care during and after a hospital stay.
The control of proceedings before a Court, by way of Directions given by a Court from time to time (usually at a Case Management Conference when the parties representatives attend).
A service that assists persons to obtain and coordinate community resources such as income assistance, education, housing, medical care, treatment, vocational preparation, and recreation.
A process of identifying individuals at high risk for problems associated with complex health care needs, assessing opportunities to coordinate care, control costs and manage a member's full spectrum of care to optimize outcome.
Planning of assistance to be provided by different care providers.
Case management is a system that insurance companies and HMO's use to ensure that individuals receive appropriate, timely, and reasonable health care services.
Medical management of catastrophic situations to insure optimal outcomes and cost effective treatment plans.
The process of facilitating the access of a patient to appropriate rehabilitation and support programs and coordination of the delivery of services.
Method designed to monitor and coordinate your treatment when you have a specific diagnosis, such as diabetes or coronary artery disease, or if you require high-cost services. Case management aims to ensure that you receive the appropriate level of services delivered in the most cost-effective manner in order to achieve the best outcome.
A system in which one individual helps the insured person and his or her family determine and coordinate necessary health care services and the best setting for those services.
A term used to describe formal services planned by care professionals.
A method of delivering health and health-related services in which one party (provider) is responsible for tracking, coordinating and approving all services to be received by a patient or client.
A planned approach to manage services or treatments to an individual with specific health care needs. The goal is to contain costs and promote more effective intervention to meet patient needs and achieve optimum patient outcome.
Identifying an individual patient’s needs and problems, and devising a method to meet those appropriately and cost-effectively. Consultation with medical professionals helps the patient take advantage of care appropriate for the patient’s condition rather than a fixed set of treatments and procedures.
A process insurers use in managed health care plans to evaluate the necessity and quality of an insured's medical care and the appropriateness of alternative treatments or solutions for the insured's medical care.
Case management is the mechanism through which persons needing assistance receive assessment services and are linked to programs. Case managers advocate for services as well as monitor programs used by persons with special needs.
A utilization management technique that addresses the medical necessity of care as well as alternative treatments or solutions, especially when the patient is likely to require very expensive treatment. Also known as catastrophic claim management, large claim management, or medical case management.
Case management is an area of practice within several healthcare professions. Most case managers are nurses or social workers.