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To be a hospital Case Manager requires experience in the hospital setting, typically as a nurse or a social worker. Additional skills specific to case management are learned in the role. Advanced certification is available to Hospital Case Managers through the Accredited Case Manager (ACM) Certification, offered by ACMA.
Medical case management is a collaborative process that facilitates recommended treatment plans to assure the appropriate medical care is provided to disabled, ill or injured individuals. It is a role frequently overseen by patient advocates .
Health care quality is the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes. [2] Quality of care plays an important role in describing the iron triangle of health care relationships between quality, cost, and accessibility of health care within a community. [3]
The Donabedian model is a conceptual model that provides a framework for examining health services and evaluating quality of health care. [1] According to the model, information about quality of care can be drawn from three categories: "structure", "process", and "outcomes". [2]
The case manager becomes an effective facilitator or enabler by use of self, understanding the social systems, the etiology of needs, and functioning of the clients. Moore in 1990s said that a case manager should possess the clinical skills of a psychotherapist and the advocacy skills of a community organizer. [10]
The National Committee for Quality Assurance (NCQA) is an independent 501(c)(3) nonprofit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation. The National Committee for Quality Assurance operates on a formula of measure ...
McAllen-Edinburg-Mission, Texas is the most affordable metro for raising multiple children, with more affordable food, transportation and healthcare, according to Creditnews. Families may also opt ...
The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS was designed to allow consumers to compare health plan performance to other plans and to national or regional benchmarks.