Question

DISCUSSION QUESTION 4-1

MH684 Managed Health Care

Lesson 4: Medical and Quality Management

Upon completion of the Required Readings, write a thorough, well-planned narrative answer to the following discussion question. Rely on your Required Readings and the Lecture and Research Update for specific information to answer the discussion question, but turn to your original thoughts when asked to apply, evaluate, analyze, or synthesize the information.  Your Discussion Question response should be both grammatically and mechanically correct, and formatted in the same fashion as the question itself. If there is a Part A, your response should identify a Part A, etc.  In addition, you must appropriately cite all resources used in your responses and document in a bibliography using APA style.

Discussion Question 1 (25 points)

Summarize the role of a case manager, including the four (4) basic functions. Then discuss at least ten (10) of the most important competencies that a good case manager should demonstrate, including the reasons for (or importance of) these competencies in the role of case management. Please refer to Box 5-3, page 131 in the text for assistance in identifying the ten selected competencies. (5 points for the summary of a case manager; 2 points each for the 10 selected competencies, 25 points total) (A 1½ -page response is required.)

Answer 1

Basic functions of case manager:

- in various settings they case manager act as patient advocate, assessor, and educator.

- They co-ordinate care between various health care providers.

- case manager perform Evidence--based knowledge, skills and Activities performed by them..

- They will be as a leaders in health care reform legislation for consumer protection and improved health outcomes..

- case manager do supervisor work for social worker to support patient and families..

Ten important competencies of case manager demonstrate:

- Engagement with a new patient for effective managed care.

- effective discharge planning with education which includes motivational interviewing, activation , return to work and behavioural change strategy..

- Develop plans which includes recommendation from multidisciplinary care team..

- The ability to co-ordinate services.

- ability to assess physical and emotional factors impacting the care..

- understanding the benefits provisions of an insurer, payer, public funding program.

- knowledge of community resources, standards, nursing practice concept..

- making accurate assessment for intervention.

- communication between the health care team, patient and families..

- provide awareness about websites where patients and families can find the information..

- case manager talented in structuring treatment plans for patients..

- They encourage social workers and committed to providing high-quality care

- Their skilled knowledge ensure more support for the patients and families.

- case manager provide individual group therapy to improve relationship and wellbeing..

- They manage the team to determine correct services and goals to care of plans..

- case manager improves staffs competencies by providing educational resources..

- They will meet budget by monitoring expenses by implementing cost savings action.

- They improve treatment for patient by analyzing,re designing process..

- communicate with clients progress by weekly interdisciplinary meeting and evaluation.

- case manager maintain health records and they make sure the safety process..