Case management service providers are tasked with providing education relevant to the effective progression of care, the appropriate level of care and safe patient transition. They provide the necessary information to the health care team and the patient/family/caregiver regarding available resources for various medical services that the patient needs. They also provide information to the patient to resolve any issues detected with their medical care in their assessment.

Case management service providers have a defined process in place for screening/identification and assessment of patients. Case managers screen the patients to identify clinical, psychosocial, financial and operational factors that can have an effect on the progression of care. They then review and ensure the plan is clinically appropriate, matches the patient’s care needs and is consistent with patient choice and available resources. Lastly, they communicate their assessment findings with the patient or their family.

The case managers will develop and coordinate a transition plan, which is based on their assessment of the patient, choices of the patient and the available resources. Case managers will intervene to prevent readmissions and evaluate patients who are readmitted to identify and implement strategies for improvement. Not only that, the case manager will assess the available community resources/potential partners and advocate for resolution of gaps in the available resources and processes. 

Case managers possess the requisite knowledge and expertise of compliance with the federal, state, local hospital and accreditation requirements. Thus, they ensure compliance regarding their scope of services.

The case manager will ensure that the patient is receiving the appropriate level of care by way of secondary physician review. They are expected to ensure timely communication to the payer of the patient’s bills to support admission, medical condition and authorization for continued stay.