The Leaders Guide To Hospital Case Management

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The Leader S Guide To Hospital Case Management

Author : Stefani Daniels
ISBN : 0763733547
Genre : Medical
File Size : 50.34 MB
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The majority of existing texts address hospital case management as a 'nursing practice.' And while it is true that most hospital case managers are, in fact, nurses, few of them are responsible for clinical care. This text addresses the role of the hospital case manager from a business perspective rather than a nursing perspective. It speaks to the relationship the case manager has with the executive team, managed care contracting office, decision support specialists, medical records staff, as well as the medical staff and clinical providers and reveals the value of engaging all of them as allies in pursuit of global objectives on behalf of every patient.
Category: Medical

Case Management

Author : Suzanne K. Powell
ISBN : 078171883X
Genre : Medical
File Size : 23.31 MB
Format : PDF, Mobi
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The Second Edition of this comprehensive "how to" text has been completely revised and updated. This text outlines the basics of case management and illustrates some of the pitfalls encountered in the field of case management. The book provides information on the new Case Management Standards, supplies standard definitions and guidelines of case management for the practicing case manager, and presents information on caring for clients in a wide variety of health care settings. New to this edition--chapters focusing on Quality Reviews and Risk Management with a strong emphasis on Continuous Quality Improvement (CQI), ethical and legal issues, and various case studies.
Category: Medical

Core Skills For Hospital Case Managers

Author : Tony Cesta
ISBN : 9781601463531
Genre : Medical
File Size : 36.52 MB
Format : PDF, Docs
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Core Skills for Hospital Case Managers: A Training Toolkit for Effective Outcomes Toni Cesta, PhD, RN, FAAN; Beverly Cunningham, MS, RN As of June 20, 2014, contact hours for nurses are no longer available with this product. Finally--an affordable, effective, and consistent training program for your hospital case managers. This one-of-a-kind guide to fundamental case management responsibilities is a necessary reference tool for every hospital case management department. This resource is designed to give case management directors and hospital leaders the tools they need to build and strengthen the basic and advanced skills their case management staff needs to succeed. "Core Skills for Hospital Case Managers" is an orientation and training manual for nurses transitioning into case management, an easy-to-read reference guide for new case managers, and a source of inspiration, tools, and resources for seasoned professionals. With a flexible format, this book and CD-ROM offer practical information and customizable tools to develop and maintain a wide variety of care management skills.Table of contents Chapter 1: Hospital Case Management 101 Chapter 2: Case Manager Role Chapter 3: Roles, Functions, and Caseloads Chapter 4: The Case Management Process Chapter 5: The Case Manager's Role in Transitional and Discharge Planning Chapter 6: Utilization Management Chapter 7: Managing Long Length of Stay Patients Chapter 8: Denials: Prevention and Appeals Strategies Chapter 9: Reimbursement Chapter 10: The Role of the Case Manager in Patient Flow Chapter 11: Measuring Success: Strategic Outcome Measures Chapter 12: Dealing with the Uninsured and Underinsured Chapter 13: Working with Multidisciplinary Teams Chapter 14: Crucial Communication and Conflict Resolution Learning objectives: Discuss the evolution of hospital case management Explain the different models of hospital case management Determine the various goals of hospital case management Examine the various roles of case management Discuss the variety of functions performed by case managers Discuss the scope of the case manager position Examine staffing ratios in various models List the steps in the case management process Determine the role of case managers in documentation Examine case managers' role in discharge planning List the factors that influence the discharge planning process Determine strategies for improving discharge planning Discuss how hospital reimbursement affects utilization management (UM) List the stages of UM coordination Determine the affect of outside influences on UM Evaluate different payers' regulations regarding UM Examine case management's role in length of stay (LOS) Evaluate strategies for managing patients with long LOS Identify data used to track and trend LOS Evaluate the reasons behind denials Discuss case management's role in preventing denials Examine case management's roles in reversing denials Examine case management's role in reimbursement Determine strategies for effective case management related to reimbursement Evaluate case management's role in patient flow Discuss demand and capacity management Identify strategies for managing patient flow Identify measurable case management outcomes Explain how case managers can track quality outcome metrics Discuss other metrics case management departments can track and trend Examine ways to create a case management report card Discuss the unfunded or underfunded patient populations Describe the role of the ED case manager with unfunded or underfunded patient populations Evaluate strategies for dealing with unfunded or underfunded patient populations Examine strategies for successfully working with multidisciplinary teams Describe sources of conflict with which case managers frequently come in contact Discuss strategies for reducing conflict Intended audience Staff nurses, charge nurses, staff educators, staff development specialists, directors of education, nurse managers, and nurse leaders
Category: Medical

Cmsa Core Curriculum For Case Management

Author :
ISBN : 0781779170
Genre : Medical
File Size : 70.76 MB
Format : PDF, ePub
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This text contains the core body of knowledge for case management practice as delineated by the Case Management Society of America (CMSA), the largest professional organization of case managers. The core curriculum provides a "synthesis of case management evolution," and presents essential elements, concepts, and vision for current and future case management practice. This edition is significantly expanded to reflect the dynamic changes taking place in case management. Each chapter is organized in a consistent format that includes learning objectives; introduction; important terms and concepts; key definitions; and references.
Category: Medical

The Nurse Leader S Guide To Business Skills

Author : Pamela Hunt
ISBN : 1601468695
Genre : Medical
File Size : 85.33 MB
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Take charge of your department's financial health and take your knowledge of healthcare management to the next level with The Nurse Leader's Guide to Business Skills. Authors Pamela Hunt, BS, MSN, RN, and Deborah Laughon, RN, BSN, MS, DBA, CCRN, provide tools to build skills and broaden understanding of the healthcare environment beyond basic budget and financial management. Forecast your department's financial resources with ready-to-use nursing tools, time-saving strategies, and sample case studies.
Category: Medical

A Guide For Nurse Case Managers

Author : Charlotte Cox
ISBN : 9781450238564
Genre : Medical
File Size : 29.72 MB
Format : PDF, ePub
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The position of nurse case managers can be a rewarding but challenging career, as these managers play a vital role in a patient’s care. In A Guide for Nurse Case Managers, author Charlotte Cox provides an insightful guide to this evolving field of medicine. Geared for those working in hospital settings, clinics, and health plan offices, this helpful reference text provides guidelines, tips, and tools for becoming a successful nurse case manager. With more than thirty years of health care experience, Cox provides a detailed overview of this important nursing position that works to usher a patient through the health care system. A Guide for Nurse Case Managers • defines the case manager role; • provides an understanding of the basics of utilization and case management; • gives an overview of Medicare and Medicaid procedures; • discusses the care planning process; • shows how to structure a community resource base. Whether you are a new case manager, a student, or a seasoned nurse needing a refresher about job basics, A Guide for Nurse Case Managers will help to shape your practice, provide valuable tips and reference tools, and help you with proven organizational ideas to succeed in the career.
Category: Medical

The Hospital Case Management Orientation Manual

Author : Peggy Rossi
ISBN : 1615692916
Genre : Medical
File Size : 38.29 MB
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The Hospital Case Management Orientation Manual Guide is a comprehensive resource that supplements of initial training for new case managers. This book explains what to document, where to document it to ensure appropriate level of care and reimbursement, and how to avoid unnecessary denials. This book's focus is utilization management, discharge planning, and relevant CMS regulations. It can help new case managers learn how to perform their jobs effectively on their own time. It can also serve as a wide-ranging resource for more experienced case managers, particularly those whose training was less than adequate.
Category: Medical

Social Services Administration In Hong Kong

Author : Chan Kam Tong
ISBN : 9789814485951
Genre : Social Science
File Size : 34.89 MB
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This book collates a number of case studies by former students from the Master of Arts (Social Work) programme whose stream of study was Social Services Administration. Many of these studies involved the action learning projects conducted by them. Academic colleagues and experienced administrators in the welfare and health sector also contribute their insights and experience regarding the major theoretical and practical issues in social services administration. Contents:Theoretical Issues in Social Services Administration:Prominent Issues Affecting Non-Governmental Organizations in Hong Kong and Its Implications to Social Work Education (K T Chan)The Dynamic Relationship Among Different Functions of Supervision (C C Yuen)Case Studies on Social Services Administration in Local Context:Adaptation of an Organization to the Environment and Its Implication to Its Internal Structure: A Case Analysis of the Hong Kong Council of Social Service before Restructuring (R W C Sezto)Continuous Quality Improvement (CQI) in Grantham Hospital (S C Leung & M L Chan)Customer Participation in Management Reform: Examples from Medical Social Service Settings (Z C L Lam)A Case Study of an Administrator in a Social Service Organization: Morality and Strategy (P F Y Chan)Prologue:Impacts of Welfare Reform on Non-Governmental Organizations in Hong Kong: Future Research Agenda (K T Chan & A Sze)and other articles Readership: Administrators, professionals and students in social services administration. Keywords:Non-Governmental Organizations;Social Services Administration;Third Sector;Civil Society;Social Work Management
Category: Social Science

The Physician Leader S Guide

Author : Richard Burton
ISBN : 156925107X
Genre : Medical
File Size : 42.78 MB
Format : PDF
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The Physicians Leader's Guide, Second Edition was updated and expanded to help you and your staff define your challenges, organize your expa nding responsibilities and take your performance to new levels. Edited by Richard Burton MD, MBA, PhD, this time-saving resource includes 15 additional, all-new, skill-building chapters, to help you excel in yo ur leadership role. From developing effective negotiation skills as a handling information systems in clinical using medical practice guidelines and evidence-based medicine to impro ve care.. you'll see how your colleagues in the healthcare industry ma stered the very same challenges you face, and how you can do it too!
Category: Medical

Hospital Case Management Models

Author : Karen S. Zander
ISBN : 160146200X
Genre : Medical
File Size : 46.72 MB
Format : PDF, ePub, Docs
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The right case management model can make or break your efforts to meet your organization's strategic goals. But how do you find the model that works for your organization and how can you garner the support you need from your organization's executive team? In this first-of-its-kind resource, case management expert Karen Zander, RN, MS, CMAC, FAAN, guides you through selecting and implementing a proven model that fits cohesively with your facility's culture in Hospital Case Management Models: Evidence for Connecting the Boardroom to the Bedside. Align case management with your organization's top strategic goals This new book will help you choose a model that aligns with your board's mission. You'll learn how to carry your model through your organization and operationalize it at the bedside through direct patient interaction by case managers and social workers. Plus, you'll get the guidance you need to gain support from your executive team.
Category: Medical

Improving Financial And Operations Performance

Author : Richard J. Priore, ScD, MHA, FACHE, FACMPE
ISBN : 9780826144645
Genre : Medical
File Size : 81.48 MB
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The increasing pressure on the bottom line of healthcare provider organizations requires leaders who understand and can adeptly apply the basic principles of effective financial and operations management. To be successful in today's environment leaders must simultaneously improve quality and service while reducing expense. Improving Financial and Operations Performance: A Healthcare Leader's Guide is a collection of proven effective tips, tools, and techniques accumulated from real-world challenges and lessons learned logically organized to provide a straightforward approach to planning, assessing, managing, and monitoring a business enterprise to improve profitability. This book provides a clear, step-by-step "how to" approach for both new and experienced leaders seeking a leg up in tackling the myriad of common and complex challenges they are facing including conducting a budget variance analysis, managing labor and non-labor productivity and expense, performing a comprehensive financial condition analysis, growing profitable volume and market share, developing an effective business case for improving quality, and evaluating the financial impact of a future project. Written for clinical and administrative leaders working in the trenches, it provides practical and applicable tools with relevant, real-world, and replicable case study examples. The essential value of Improving Financial and Operations Performance: A Healthcare Leader's Guide is improving decision-making effectiveness, enhancing operations efficiency know-how, and developing strong financial management acumen to overcome the challenges in today's healthcare environment. Key Features: Author experience with extensive expertise as a former investor-owned hospital CEO, integrated health system vice president, managing director for the renowned turnaround experts, the Hunter Group, and graduate business school professor in management, finance, and economics. Realistic case examples to apply the key lessons through detailed practical and relevant case studies using clear step-by-step instructions. Calls-to-action at the end of each chapter with critical leadership imperatives to help prioritize and focus efforts on what matters most. Comprehensive glossary of key terms and concepts using plain easy to understand language. Appendices and Excel templates containing easy-to-use plug-and-play financial worksheets, checklists, best practice pathways, and performance assessments.
Category: Medical

A Case Manager S Study Guide

Author : Denise Fattorusso
ISBN : 0763732990
Genre : Medical
File Size : 70.47 MB
Format : PDF, ePub, Mobi
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This is the most comprehensive print and electronic combination study guide case management certification! It contains the most up-to-date information, assures a uniform base knowledge for the successful case manager, and provides: study questions and practice exams to help you assess your skills and needs.
Category: Medical

Social Work

Author : Nena Scott
ISBN : 1556457286
Genre : Medical
File Size : 72.83 MB
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Social Work: Strength-Based Practice in Hospital Case Management Bonnie Geld, MSW Shawna Grossman Kates, MSW, MBA, CMAC Contributors: Matt Boettcher, LMSW-AP, LCSW, MSW Linda Brandeis, ACSW, LICSW Eleni Carr, MBA, LICSW Scott Ferguson, MSW, LCSW, ACM Jeanette Foster, MSW, LISW-S Theresa E. Jenner, MSW, LICSW Jill Karnes, MS, MSW, LISW-S Dara Kates Katz, LCSW, ACSW Evelyn Mascareñas, ASW Lori McCullough, MSW, LISW-S, C- Renee Michelsen, MSS, Lawrence Pellegrini, MSW, MPA, and PhD candidate Nancy Shendell-Falik, RN, MA Roy Sittig, MD, SFHM June Stark, RN, BSN, Vicki Weiner, MSW, MA, LCSW, CCM Social workers and case managers work to identify resources to meet primary social welfare needs; at their core, they demonstrate key skills of assessing, brokering, engaging, partnering, risk managing, and problem solving. However, many case management managers and directors need help understanding the social work done in their departments as well as pinpointing what support or mentoring social workers need. Case management directors don't always know how to align social workers and RN case managers to maximize care coordination, discharge planning, and other case management functions for patients. To make matters worse, there is a lack of resources for managing social work programs and the activities that are shared between case managers and social workers. Social Work: Strength-Based Practice in Hospital Case Management will help case managers manage their social work resources and staff members to achieve optimal results as well as maximize the social work being done in their departments. This resource will offer insight into the critical role, contributing value, and significant need of social workers within the healthcare continuum. It will address capitalizing not only on social work strengths but also on valuable tools used to demonstrate measurable care management outcomes. This resource will also present the nursing staff's important perspective and offer suggestions on developing and supporting essential synergies between social work and multidisciplinary teams. Table of Contents Introduction Components of Hospital Social Work Capitalizing on Social Work Skills and Strengths in Case Management Social Work Models in Healthcare Professional Development The Value of Social Work Practice Tying Social Work to Outcomes Partnerships and Department Collaborators Leadership Breaking the Social Work Glass Ceiling in Healthcare Widening the Landscape Conclusion Who should read this book? Case managers Case management directors and managers Social workers Nurse directors and managers Care management directors and managers Nurses
Category: Medical

Creating A Just Culture

Author : Vivian B. Miller
ISBN : 9781601467652
Genre : Medical
File Size : 50.50 MB
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Creating a Just Culture: A Nurse Leader's Guide Vivian B. Miller, BA, CPHQ, LHRM, CPHRM, FASHRM Step-by-step guidance to create and sustain a just culture at your facilityThis practical resource explains the process of creating and sustaining a just culture in which staff members are encouraged to report adverse events to improve quality care. You ll get sure-fire strategies to gain buy-in from leadership, improve employee satisfaction, and turn mistakes and near-misses into useful data to improve processes and reporting. Help your nurses understand it s not the who but the what that went wrong. This book will help you: Overcome potential roadblocks to culture change with successful strategies from accomplished patient safety, risk, and nursing experts Motivate staff to report adverse events Discover how a just culture increases patient safety, nurse satisfaction, and retention Evolve your current culture into a just culture using the easy-to-understand, step-by-step instructions You also receive helpful tools such as: Sample timeline for just culture implementation Just culture policy from a leading hospital Staff education checklist Take a look at the table of contents Chapter 1: Why a Just Culture? National Emphasis on Patient Safety Avoiding Toxic Work Environment Your Professional Duty Why Staff and Patients Should Care Enhancing Recruitment Retaining Staff Get Ahead with Public Reporting Chapter 2: Assess Your Organization Policy and Procedure Mandatory Reporting Policy and Regulation Assess Your Staff s Knowledge Undertake a Cultural Assessment Chapter 3: Plan the Change Leverage Current Strengths Identify Stakeholders Identify Champions Establish Symbols of Change Chapter 4: Identify Desired Outcomes Increasing Occurrence Reporting Reporting New Errors Open Discussions of Change Use of FMEA Chapter 5: Implementation Strategies Provide Training Supporting Errors Occurring Within Your New Culture Emphasizing Values of Courage, Honesty, and Integrity Teaching Peers To Support and Comfort Streamlining Error Reporting Chapter 6: Evaluate the Change Benchmarking Within and Outside of Your Organization Resurveying Your Hospital Monitoring Your Progress Chapter 7: Case Scenarios and Expert Advice Chapter 8: Weighing Ethical Decisions Cultural Barriers to Disclosure Items to Include in Disclosures Who Should Disclose Exceptions to Disclosure "
Category: Medical

Introduction To Health Care Management

Author : Sharon B. Buchbinder
ISBN : 9780763790868
Genre : Law
File Size : 60.72 MB
Format : PDF, ePub
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Instructor Resources: Tranisition Guide, Instructor's Manual, PowerPoint Slides, Case Studies, TestBank, Traditional Syllabus, and an 8-week online course Syllabus
Category: Law

Hospitals Health Care Organizations

Author : David Edward Marcinko
ISBN : 9781466575813
Genre : Business & Economics
File Size : 28.22 MB
Format : PDF
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Drawing on the expertise of decision-making professionals, leaders, and managers in health care organizations, Hospitals & Health Care Organizations: Management Strategies, Operational Techniques, Tools, Templates, and Case Studies addresses decreasing revenues, increasing costs, and growing consumer expectations in today‘s increasingly competi
Category: Business & Economics

Leadership And Nursing Care Management

Author : Diane Huber
ISBN : 9781455740734
Genre :
File Size : 55.13 MB
Format : PDF
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Research Notes in each chapter summarize relevant nursing leadership and management studies and show how research findings can be applied in practice. Leadership and Management Behavior boxes in each chapter highlight the performance and conduct expected of nurse leaders, managers, and executives. Leading and Managing Defined boxes in each chapter list key terminology related to leadership and management, and their definitions. Case Studies at the end of each chapter present real-world leadership and management situations and illustrate how key chapter concepts can be applied to actual practice. Critical Thinking Questions at the end of each chapter present clinical situations followed by critical thinking questions that allow you to reflect on chapter content, critically analyze the information, and apply it to the situation.A new Patient Acuity chapter uses evidence-based tools to discuss how patient acuity measurement can be done in ways that are specific to nursing. A reader-friendly format breaks key content into easy-to-scan bulleted lists. Chapters are divided according to the AONE competencies for nurse leaders, managers, and executives. Practical Tips boxes highlight useful strategies for applying leadership and management skills to practice.

The Gerontology Nurse S Guide To The Community Based Health Network

Author : Brenda L. Bonham Howe, MSN, RN, BSLS
ISBN : 9780826127020
Genre : Medical
File Size : 77.47 MB
Format : PDF
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This is a timely and vital resource for new and seasoned gerontology nurses responsible for coordinating care and advocacy for their patients as health care shifts from hospital-based to community-based care. Comprehensive and organized for quick access to information, this clinical guide encompasses the broad network of community health resources available and describes how to access them on behalf of geriatric patients and clients. It provides an overview of growing old in the United States and discusses cultural and socioeconomic considerations, common conditions and morbidities affecting older adults, and the wide variety of community resources available to address these concerns. The book provides the critical information gerontology nurses need to synthesize the health conditions affecting older adults with education about and access to vital community-based services. It discusses health delivery in regard to cultural diversity, the physical and psychological changes of aging and how to adapt to them, and different types of community-based health options including home health services, independent and assisted living, long-term care, and hospice and palliative care. Woven throughout are the themes of empowerment and advocacy for the nurse, patient, and family. Included in each chapter are abundant tools and resources that can be quickly referenced, and there is an emphasis on patient advocacy and teaching throughout. The book is also a supportive resource for nursing education programs and for nurses in mentorship roles in hospital or primary clinical practice settings. Key Features: Encompasses the broad network of community health resources available to older adults Provides easy access to informational websites, tools, and resources Addresses the physical and psychological changes of aging Focuses on advocacy and empowerment Serves as a comprehensive resource for new and seasoned gerontology nurses, educators, and mentors
Category: Medical