Health Care Team (HCT)

The terms Care Manager and Case Manager are used interchangeably depending upon the particular setting and/or facility. Care/Case Managers work in a variety of health care settings, including acute inpatient hospitals, managed care organizations, home care agencies, community agencies, workers’ compensation, disability, skilled nursing facilities, and occupational health. This summary addresses the hospital-based Care/Case Manager in the acute care setting. The hospital Care/Case Manager works closely with the patient and his or her family, along with the physician and the health care team, to move the patient from one phase of care to the next. This facilitating/coordinating role may include discharge, transitional planning, or utilization management.

The definition of case management as outlined in the Case Management Standards of Practice and approved by the Case Management Society of America is “a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality cost-effective outcomes.”

Hospital care/case management models can vary from facility to facility. One of the more common models used in acute care facilities is the integrated care/case management model of utilization management, discharge planning, outcomes management, and variance analysis.

The hospital Care/Case Manager assesses the patient’s needs, typically for a home discharge or to another health care facility, develops a plan of care based on his or her assessment, facilitates the plan of care, and advocates for the patient.

The hospital Care/Case Manager is typically a licensed registered nurse with previous hospital and/or home care experience. Medical social workers can also be found in acute care settings. This type of care management may focus on the long-term care of patient populations at risk for re-hospitalizations or long-term care placement.

Hospital Care/Case Managers are supervised by the director or manager of Care/Case Management.

Patients who would benefit from the care of a Care/Case Manager include geriatric patients, patients with chronic care needs, and patients requiring transitional planning to home care, nursing homes, assisted living facilities, etc.

Depending upon the particular hospital’s policies, a Care/Case Manager can get involved with the patient at admission or when the patient is stable enough for discharge or transitional planning.