Overview
Developed for professionals and firms who are new to the growing field of insurance-based or external case management, this practical handbook focuses on case management in accident/health and property/casualty insurance including workers' compensation. It presents a step-by-step approach to assist both new and experienced case managers. For the novice, it provides information on roles and responsibilities of a case manager, how to start a case management program, a functional description of insurance systems, and information on hiring and training case managers. More experienced case managers will benefit from discussion of effective marketing to help increase business, better supervision of case managers to maintain quality, and fee negotiation for better cost savings through case management.
* Covers all key aspects of healthcare delivery systems, both inpatient and outpatient.
• Addresses cutting-edge issues such as the future of case management, disease management, risk management, telephonic vs. onsite case management, and vocational rehabilitation.
• Provides a detailed unit on how to set up and operate an effective case management program.
• Includes useful appendices that provide sample forms, report formats, checklists, and examples of criteria that eliminates the need to develop new case management tools.
The book contains no figures.
Editorials
From The Critics
Reviewer: Roberta M. Conti, PhD, RN, CCM(George Mason University College of Health and Human Services)Description: This book focuses on case managers working for third party payers and insurance companies.
Purpose: Its primary purpose is to provide definitive practice guidance for payer-based case managers. Proposed objectives are to provide training, program establishment guidelines, and comprehensive and fundamental information. These objectives attend to the core competencies required of case managers in payer-based systems. The content is addressed in a clear, comprehensive manner.
Audience: The authors' primary audience is novice case managers working in the payer-based model of case management. Secondary audiences include experienced case managers and insurance professionals. This book could be used in continuing education and in academic courses.
Features: The authors comprise an interdisciplinary group representing nursing, vocational rehabilitation counseling, and clinical psychology. Their educational preparation, credentials, and experience indicate they are credible experts. Illustrations are organized across four appendixes and include example forms and communications used in case work, as well as example practice criteria. They provide good examples for novice case managers. However, the formats do not easily allow for application of information technology in data collection. References are current and include appropriate publications. The table of contents clearly identifies major sections and subsections. Heading structures assist the reader to easily identify content focus. The book's softbound cover, size, and shape make it easy to use. Unique features include a well-done glossary, attention to vocational rehabilitation, chapter end suggested readings, and use of a cumulative numerical footnote system.
Assessment: This is a well written, payer-based practice guide of particular usefulness to novice case managers. Comparative examples are an especially effective writing technique. The book is comprehensive in its scope, including topics like ethical practice. Practicing case managers in payer-based models, insurance professionals, libraries, and educators who wish to use it as a supplemental text should buy it.
Roberta M.Conti
This book focuses on case managers working for thirdparty payers and insurance companies. Its primary purpose is toprovide definitive practice guidance for payer-based case managers. Proposed objectives are to provide training, program establishmentguidelines, and comprehensive and fundamental information. Theseobjectives attend to the core competencies required of case managers inpayer-based systems. The content is addressed in a clear,comprehensive manner. The authors' primary audience is novice casemanagers working in the payer-based model of case management. Secondary audiences include experienced case managers and insuranceprofessionals. This book could be used in continuing education and inacademic courses. The authors comprise an interdisciplinary grouprepresenting nursing, vocational rehabilitation counseling, andclinical psychology. Their educational preparation, credentials, andexperience indicate they are credible experts. Illustrations areorganized across four appendixes and include example forms andcommunications used in case work, as well as example practice criteria. They provide good examples for novice case managers. However, theformats do not easily allow for application of information technologyin data collection. References are current and include appropriatepublications. The table of contents clearly identifies major sectionsand subsections. Heading structures assist the reader to easilyidentify content focus. The book's softbound cover, size, and shapemake it easy to use. Unique features include a well-done glossary,attention to vocational rehabilitation, chapter end suggested readings,and use of a cumulative numerical footnote system. This is awellwritten, payer-based practice guide of particular usefulness to novicecase managers. Comparative examples are an especially effectivewriting technique. The book is comprehensive in its scope, includingtopics like ethical practice. Practicing case managers in payer-basedmodels, insurance professionals, libraries, and educators who wish touse it as a supplemental text should buy it.3 Stars from Doody