Case Management

Divide and conquer: Taking the UR out of case management

Case Management Monthly, October 1, 2010

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To begin to think about separating the UR function from the case management role, you must question the validity of the functional model, according to Stefani Daniels, RN, MSNA, CMAC, ACM. Daniels is managing partner at Phoenix Medical Management, Inc., in Pompano Beach, FL.

Some facilities now find that their case managers are more useful on the floor interacting with patients and physicians, rather than performing chart reviews, she says.

“I think many facilities recognize that if case managers are really going to monitor progression of care, coordinate care, and improve transitions, they can’t have their noses buried in charts,” says Daniels.

These facilities use an outcomes model that measures case management success by: 

  • Assigning appropriate level of care
  • Facilitating progression of care
  • Improving delivery-of-care processes
  • Orchestrating team support for safety and quality
  • Promoting safe transitions of care
  • Influencing responsible use of resources
  • Reducing risk, fragmentation, and inefficiencies
  • Advocating for patients

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Case Management Monthly.

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