Q&A: Core competencies for a case manager

October 25, 2017
Medicare Web

Q: What are the core competencies of a case manager?

A: Patients, their families, and healthcare professionals assume that case managers and physicians who provide CM services are competent. Remember to follow the hospital’s policies and procedures and act within the realm of the job description for the role as well as any standards outlined by a state’s Practice Act (e.g., nurse or SW), which can be located on the state’s licensing board website. 

A competent case manager does the following:

  • Relies on accurate assessments for interventions 
  • Develops plans that include recommendations from multidisciplinary care teams 
  • Establishes specific goals

The CM process for nurses is the nursing process or scientific method taught in nursing school—assessment, goal planning with interventions, implementing, and evaluating results. 

The sum total of the knowledge and values that case managers bring to the job reflects their competency. Competent performance requires knowledge, skill, and energy that arise from an honest belief in the work. Book knowledge is important, but so is practical application of that knowledge. 

CMSA’s five core competencies include the following:

  • The ability to assess physical and psychological factors impacting the case
  • The ability to coordinate service delivery 
  • The ability to understand the benefit provisions of an insurer, the various types of payers, as well as the public funding programs to which a patient might be entitled 
  • Knowledge of nursing practice concepts
  • Knowledge of community resources, levels of care, as well as the standards for care within the community resources

For more information, see The Hospital Case Management Orientation Manual.

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