Roles, Training, and Qualifications of a Case Manager in the Canadian Health Care Industry: A Narrative Review.

PURPOSE: The purpose of this article is to explore primary roles, training, competencies, and qualifications of a case manager in the Canadian health care industry and how to improve case management practice in Canada. PRIMARY PRACTICE SETTING: Case managers' primary practice setting investigated in this article is the Canadian health care industry, which includes clinics, hospitals, continuing care, short-term and long-term care facilities, as well as palliative and end-of-life care settings. CONCLUSION: The main role of case managers is to help clients meet their goals. Assessment, monitoring, interpersonal communication, and collaboration are essential roles and competencies of case managers. Many case managers come from regulated health care professions and have prior years of professional experience, and many of them come from a nursing profession. This article is a narrative review based on the current literature about case managers' roles, training, and competencies in the Canadian health care industry and how to improve Canadian case management practice. Certification and standardization of case managers in Canada are needed to better understand the roles, training, and qualifications of case managers in the Canadian health care industry. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Case managers require skills in assessment, monitoring, cultural competency, interpersonal communication, collaboration, coordinating, and advocating for resources and services to meet clients' goals in the health care industry. Case managers must also consider how to combat and address other social determinants of health such as a client's social economic status, literacy, income, employment, and working conditions that influence client's health. Ongoing professional development for case managers is fundamental in achieving effective case management practice. Finally, it is important to have case management certification in Canada in order to better understand case manager's roles and qualifications in the Canadian health care industry.

"You don't want anyone who hasn't been through anything telling you what to do, because how do they know?": Qualitative analysis of case managers in a hospital-based violence intervention program.

STATEMENT OF PURPOSE: Intentional violent injury is a leading cause of disability and death among young adults in the United States. Hospital-based violence intervention programs (HVIPs), which strive to prevent re-injury through intensive case management, have emerged as a successful and cost-effective strategy to address this issue. Despite the importance of strong therapeutic relationships between clients and their case managers, specific case manager behaviors and attributes that drive the formation of these relationships have not been elucidated. METHODS: A qualitative analysis with a modified grounded theory approach was conducted to gain insight into what clients perceive to be crucial to the formation of a strong client-case manager relationship. Twenty-four semi-structured interviews were conducted with prior clients of our hospital's HVIP. The interviews were analyzed using constant comparison method for recurrent themes. RESULTS: Several key themes emerged from the interviews. Clients emphasized that their case managers must: 1) understand and relate to their sociocultural contexts, 2) navigate the initial in-hospital meeting to successfully create connection, 3) exhibit true compassion and care, 4) serve as role models, 5) act as portals of opportunity, and 6) engender mutual respect and pride. CONCLUSIONS: This study identifies key behaviors of case managers that facilitate the formation of strong therapeutic relationships at the different stages of client recovery. This study's findings emphasize the importance of case managers being culturally aligned with and embedded in their clients' communities. This work can provide a roadmap for case managers to form optimally effective relationships with clients.

Informing the Professional Case Manager's Career Path: Five Lessons.

Professional case management's career path offers countless opportunities to pursue, from attainment of the highest levels of licensure and credentialing to education, and that terminal degree. Defining each point of the journey and individual milestones warrants keen attention to a number of areas. All of these decisions and options evolve in response to the industry landscape, as well as professional and personal development. Five key lessons provide case managers clear starting points to consider the most appropriate career path to travel amid a landscape marked by constant change.

The Evolving Role of the Professional Case Manager: A National Study From the Commission for Case Manager Certification: Part 2.

PURPOSE: The purpose of the national role and function study was to identify the essential activities and necessary knowledge areas for effective professional case management practice from the perspective of those directly involved. The study also aimed to inform the relevance and currency of the blueprint for the case management certification examination. PRIMARY PRACTICE SETTINGS: The national study covered the diverse case management practices and/or work settings across the full continuum of health and human services and numerous professional disciplines. METHODOLOGY AND SAMPLE: This cross-sectional descriptive study used the practice analysis method and online survey research design. It employed a purposive sample of 2,810 certified and not yet certified case managers who responded to an open participation link made available as an online survey. The final study sample supported the conduct of meaningful statistical analyses including multiple subgroup comparisons. RESULTS: The study identified the common activities (6 domains) and knowledge areas (5 domains) necessary for effective performance by professional case managers. Part I of this 2-part article series described the background of the participants and their perspectives of the practice and the knowledge applied by those responsible for the case manager's role. Part II, as shared in this article, reports on the factor/principal component analysis and how such activity informed the needed update of the test specifications for the Certified Case Manager (CCM) certification examination. The update reflects the continued evolution of the professional case management practice and ensures that the examination remains current and relevant. Of special note is the maturation of the case management practice; for example, greater emphasis on quality, safety, and outcomes; baccalaureate or higher education; and recognition of the value of certification. In addition, the 2019 role and function study has revealed that utilization review/management is evolving potentially as a function that is separate from that of the case manager. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The study has identified the essential activities and knowledge areas of case management practice at both the micro and macro levels. These findings represent the substantive evidence of practice, keeping the CCM credentialing examination evidence-based and maintaining its validity for evaluating the competency of professional case managers. They have also documented the evolution of the practice over the past 5 years. Moreover, the findings may inform the development of programs and curricula for the training and advancement of case managers. The study instrument also is beneficial for use in further research into professional case management practice.

Highly Reliable Case Management.

Health care is a highly complex system that is prone to error. Professional case managers across the continuum of care are key stakeholders who can significantly impact the effectiveness and efficiency of health care delivery at the individual and population health levels. This article explores how professional case managers can use evidence-based practice and generative knowledge to improve professional practice. In addition, the authors provide examples of how to actively support continuous change and high reliability within an organization.

Understanding the Increasing Role and Value of the Professional Case Manager: A National Study From the Commission for Case Manager Certification: Part 1.

PURPOSE: The purpose of the national role and function study was to identify the essential activities and necessary knowledge areas for effective professional case management practice from the perspective of those currently functioning in such roles in various care settings and across diverse professional disciplines. PRIMARY PRACTICE SETTINGS: The national study covered the diverse case management practices and/or work settings across the full continuum of health and human services. METHODOLOGY AND SAMPLE: This cross-sectional descriptive study used the practice analysis method and online survey research design. It employed a purposive sample of case managers, in which an open participation link was e-mailed to nearly 60,000 case managers, both certified and not yet certified. A total of 5,416 responses were received, of which 2,810 were found to be acceptable for consideration in the study. A representative group of individuals engaged in case management completed the survey in sufficient numbers to meet the requirements for conducting meaningful statistical analyses including subgroup comparisons. RESULTS: The study identified the common activities (6 domains) and knowledge areas (5 domains) necessary for competent and effective performance by professional case managers, as highlighted in this article, which is the first of a 2-part series on the 2019 role and function study. The results informed the needed update of the test specifications for the Certified Case Manager (CCM) certification examination, as will be delineated in Part II of this article series. The update was necessary because case management practice has continued to evolve and to ensure the examination reflects current practices. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The study identified essential activities and knowledge topics at both the micro- and macro levels that define competent and effective professional case management practice, also referred to as the substantive evidence of practice. It helps keep the CCM credentialing examination evidence-based and maintain its validity for evaluating the competency of professional case managers. In addition, the findings document how the practice has evolved over the past 5 years since the conduct of the last national study. Moreover, findings inform the development of programs and curricula for the training and advancement of case managers. The study instrument also is beneficial for further research into professional case management practice-most importantly linking the roles and functions of case managers to client care outcomes.

Care managers in rural Japan: Challenges to interprofessional collaboration.

Effective interprofessional collaboration for care managers is vital for the care of older people. This study's aim was to inquire into the obstacles to interprofessional collaboration faced by care managers in rural areas of Japan. Forty-six care managers participated in group discussions and semi-structured interviews, and the qualitative data were analyzed using thematic analysis. Five themes related to obstacles emerged from the analysis regarding relationships with physicians, professional competency, relationships among other professionals, environmental constraints, and relationships with nonprofessionals. Other professionals' unfamiliarity with the care manager's role and a lack of mutual understanding, boundaries, and information sharing among medical professionals were also cited as issues.

Transition From Hospital to Home: The Role of the Nurse Case Manager in Promoting Medication Adherence in the Medicare Population.

Lack of adherence to medication plans is a factor in costly hospital readmissions. Adherence to medication plans in the home care setting in relation to hospital readmission is a major issue among the Medicare population. Nurse case managers are in a key position to provide care after hospital discharge to promote medication adherence and thus reduce the chance of hospital readmission. This article discusses barriers to taking medications as prescribed and directed, the importance of ongoing medication reconciliation at home, and strategies to promote adherence to medication plans.

Integration of the National Comprehensive Cancer Network (NCCN) Distress Screening Tool as a Guidepost for Telephonic Oncology Case Management.

PURPOSE OF STUDY: Cigna's oncology case management programs identified the opportunity for case managers to integrate distress screening as recommended by the National Comprehensive Cancer Network (NCCN) in oncology populations. Our purpose in conducting this study was to quantify oncology case management program improvements as a result of using the NCCN Distress Screening Tool to guide telephonic case management. The program improvements we measured comprised more efficient identification of biopsychosocial problems and appropriate resource referrals. PRIMARY PRACTICE SETTING: Case managers in a large commercial health plan piloted integration of distress screening into telephonic case management among U.S. oncology customers experiencing a new diagnosis or care transition from September 2016 to April 2017. METHODOLOGY AND SAMPLE: A retrospective, matched case-control study was conducted among Cigna customers eligible for oncology case management. The pilot group of 317 received distress screening early in the oncology case management assessment. Outcomes included distress severity ranging from 0 to 10 (where 0 = no distress, 1-3 = mild, 4-7 = moderate, and 8-10 = severe), identification and number of biopsychosocial health problems, and percentage of direct resource referrals by case managers to supportive services. RESULTS: More than half (54%) of the screened customers reported mild or greater distress, and there was a strong correlation between degree of distress and average numbers of biopsychosocial health problems or direct resource referrals. Screened customers were 16% more likely to be referred to internal and external resources than customers not screened with the tool (66% vs. 50%, χp < .001). IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: This study advances evidence-based oncology case management practice during care transitions by providing quantitative evidence for the utility of integrating the NCCN Distress Screening Tool into telephonic oncology case management. Using the tool (thermometer and problem list) to guide telephonic oncology case management and care coordination facilitated more tailored referrals to individuals with cancer enrolled in a large commercial health plan. On the basis of our findings, we integrated distress screening to address unmet biopsychosocial needs in patients with cancer.