CM 565: The Case Manager: Role & Applications II

Course overview

This course is part II of an advanced course in case management with a comprehensive focus of study on the roles and the applications of professional Case Manager practice. Throughout this course students will examine in-depth information related to the many roles of the professional Case Manager and how they integrate their roles into many different models of case management practice today. Emphasis is on examining models of professional case management with Case Manager Applications of practice including theory and process. Students will be able to comprehend not only the role of the Case Manager but also the applications of professional practice in a wide variety of care settings. Students will examine key learning concepts such as reimbursement resources and challenges while practicing case management and financing of client's medical benefits. Students will study health care reimbursement in both the private sector and the employer sector. Also examined are group medical plans, HMOs, PPOs, and Point of Service Plans, Disability Plans, traditional and self-funded insurance plans and riders to life insurance policies are presented. A study of the case manager's role in working with claims departments is presented as well. In this course we examine key leadership and management roles of the case manager in the practice of professional case management and the key skills needed in todays challenging practice environment. New strategies for leading a case management department are examined. Students will study Predictive Modeling and Case Stratification and implications for their use in practice. Also examined in this course are : new characteristics of today's health care system, the case manager's role in the era of value-based health care, and new case management and health care provider approaches for managing the high-risk and high-cost patients. Students will then examine and study key topics focused on current challenges and emerging trends in case management which include: the aging population, medical advancements, dying in America, medication management, pain management, multiculturalism, health literacy, obesity, models of behavioral health in primary care, health care technology and trends, transformative health care approaches for the Millennial Generation and the ACA and its implications for case management practice. Students will use a required textbook which they must purchase and will also be viewing Videos for this course. Pre-requisite: must be an RN or an LPN to take this course. May also be a Social Worker or other Behavioral health care Specialist. Others who may take this course include: Respiratory Therapists as well. Other Pre-requisite: It is strongly advised you take Part I of this course first: CM 545: The Case Manager: Role and Applications I, which is offered by this provider.