Case Management Concepts: Process, Models, and Roles
Defining the work
Case management is a collaborative process of assessment, planning, facilitation, coordination, monitoring, and evaluation of options and services to meet an individual's health needs. Its purpose is to promote quality and cost-effective outcomes through communication and available resources. Candidates should be able to separate case management from utilization review (a cost and appropriateness function) and from care coordination (a narrower activity that is one component of the larger process).
The process
Know the sequence and purpose of each function: case finding and screening, intake, comprehensive assessment, problem identification, care planning with measurable goals, implementation, coordination, monitoring, evaluation, and termination or transition. Assessment must precede planning; goals should be client-centered, specific, and time-bound. Documentation should be objective, timely, and tied to the plan.
Models and roles
Understand the brokerage model (the case manager links the client to services with limited ongoing involvement), the strengths-based or empowerment model, and the role set of advocate, broker, negotiator, educator, and facilitator. Advocacy means acting on behalf of the client; negotiation means reaching agreement among parties. Case managers practice across acute, ambulatory, behavioral health, workers' compensation, and long-term care settings, guided by professional standards and certification bodies.
Traps to watch
Questions often scramble process steps, treat case finding as passive referral intake, or imply that client-centered care means the client dictates every decision without informed discussion.
Worked example
A patient with repeated emergency visits is flagged by a utilization report. The correct first action is a comprehensive assessment of needs, supports, and barriers, not immediate enrollment in a disease-management program or a discharge-planning referral.