Case management is a collaborative process that includes the assessment, planning and coordination of options and services to meet a patient’s medical care needs. Effective case management utilizes available resources to achieve high-quality and cost-effective outcomes.

Discharge planning is one function of case management. In the hospital setting, case managers assist patients and families in developing a discharge plan, including coordination of community based medical services and, when necessary, admission to a post-acute care facility, such as an acute rehabilitation unit or hospital, or skilled-nursing facility.

Another function of hospital case managers is utilization review (UR). UR is a cost control mechanism, whereby the appropriateness, necessity and quality of health care services are monitored by payers and providers. Hospital case managers assist in this process by providing clinical information to payers, monitoring length of stay, seeking necessary care authorizations, and appealing medical denials. 

In health care settings, case managers are most often nurses or social workers. CHA supports the case management staff of our member facilities through communications and advocacy at both state and federal levels.