overview

Continuing Education

At the OU College of Nursing learning never ends. We offer a variety of continuing education opportunities for those who wish to broaden their educational journey.

Professional Case Management for Nurses and Social Workers Outline

Course Outline

Part I: Advanced Concepts of Case Management explores the concept of case management as the timely coordination of quality healthcare services to meet specific health care needs in a cost-effective manner to promote positive client outcomes. Content areas to be explored include:

  • Case Management knowledge and relationships
  • Integrated care management
  • Community resource utilization and social support
  • Outcomes care management

Course Objectives

At the conclusion of the course, the learner will be able to:

  1. Describe the essential functions, various roles and practice settings of case management.
  2. Describe legislation which has impacted case management.
  3. Identify the standards of practice for case management.
  4. Describe the processes of case management assessment, consultation and referral.
  5. Describe resource and utilization management issues in the current healthcare delivery system.
  6. Discuss key concepts regarding the case managers' relationship with the client/consumer.
  7. Identify issues pertinent to care recording and documentation.
  8. Discuss the process for evaluating client/consumer outcomes.
  9. Describe pertinent legal and ethical issues.
  10. Review professional case management resources and certification requirements.

Module Objectives

Module 1: Case Management Roles and Functions

  1. Define case management
  2. Describe the philosophy and objectives of case management
  3. Describe the essential functions of case management (CMSA)
    1. Assessment-screening tools
    2. Planning
    3. Implementation
    4. Coordination
    5. Monitoring
    6. Evaluation
  4. Identify various roles of the case manager
  5. Discuss the role of the case manager in psychological and rehabilitative care.

Module 2: Historical Basis of Case Management

  1. Describe the historical origins of the concept of case management
  2. Review the following legislation which has impacted care management
    1. Rehabilitation
      1. Rehabilitation Act of 1973
      2. Social Security Act of 1935
      3. Smith-Hughes Act 1917
      4. Smith-Fess Act 1920
    2. Managed care
      1. Emergency Medical Treatment and Active Labor Act (EMTLA)
      2. Health Insurance Portability and Accountability Act (HIPAA) of 1996
      3. Final Rule on Patient Privacy Regulations of the HIPAA ACT
      4. Omnibus Budget Reconciliation Act (OBRA) 1989, 1990
      5. Patient Self Determination Act of 1990
      6. Uniform Anatomical Gifts Act
    3. Disability
      1. Americans with Disabilities Act of 1990
      2. Architectural Barriers Act of 1968
      3. Education for All Handicapped Children Act (EAHCA)
      4. Social Security Disability Income (SSD)
      5. Social Security Act 1935
      6. Urban Mass Transit Act
    4. Employer
      1. Title I of the Americans with Disabilities Act (A.D.A.)
      2. Consolidated Omnibus Budget Reconciliation Act (COBRA)
      3. ERISA
      4. Family and Medical Leave Act of 1993 (FMLA)
      5. Longshore and Harbor Workers’ Compensation Act of 1928
      6. Occupational Safety and Health Administration Act (OSHA)
      7. OSHA Ergonomics Final Rule
      8. Omnibus Budget Reconciliation Act (OBRA) of 1986
      9. Tax Equity and Fiscal Responsibility Act (TEGRA) of 1982
      10. Workers’ Compensation Act of 1911

Module 3: Standards of Practice

  1. Identify the Case Management Society of America’s (CMSA) Standards of practice for Case Management
  2. Describe the eight performance indicators identified by CMSA.

Module 4: Integrated Care Management

  1. Review case management models.
  2. Define integrated care management.
  3. Describe the role of the case manager in integrated care management.
  4. Describe disease management issues in integrated care management.
  5. Describe the case manager’s interventions in complex psychological, psychosocial and rehabilitative care.
  6. Analyze issues pertinent to return-to-work for the client/consumer.
  7. Describe the process of integrated care management consultation with other healthcare professionals.
  8. Describe the process of integrated care management coordination when working with different organizations and providers.
  9. Describe the referral process.

Module 5: Healthcare Delivery System

  1. Describe the healthcare delivery system as it relates to managed care.
  2. Describe healthcare reimbursement systems.
  3. Identify factors that impact client/consumer benefit coverage.
  4. Discuss the process of denials and appeals.
  5. Describe community resources available to military case managers.
  6. Describe the process for procurement of supplies and equipment in military case management.

Module 6: Soldier/Family Relationships with the Case Manager

  1. Describe the case manager’s role in creating a professional relationship with the soldier/family.
  2. Describe culturally sensitive and competent care.
  3. Discuss appropriate professional boundaries and interactions between the soldier/family and the case manager.

Module 7: Documentation of the Essential Functions of Case Management.

  1. Identify essential pieces of documentation needed to document integrated care management.
  2. Discuss the documentation pertinent soldier/family teaching.
  3. Describe the documentation needed for transitional care.

Module 8: Outcomes Management

  1. Monitor for best practices through benchmarking.
  2. Analyze cost versus benefits in integrated care management.

Module 9: Case Management considerations in Legal and Ethical Issues

  1. Describe ethical principles in integrated care management.
  2. American Nurses Association Code of Ethics for Nurses
  3. Ethical Decision Making
  4. Discuss the process of completion of legal forms including advance directives
  5. Managing confidentiality including HIPAA legislation.

Module 10: Professional Case Management

  1. Identify professional case management resources.
  2. Identify case management certification guidelines from various organizations.

Part II: Advanced Concepts of Case Management explores advanced concepts, issues and trends of relevance to the practice of case management.

Course Objectives

By the end of this continuing education course, the learner will be able to:

  1. Evaluate novice to expert roles in case management.
  2. Evaluate selected case management procedures
  3. Describe the components of effective case management administration
  4. Describe the major trends and opportunities in case management
  5. Analyze issues of importance to the practice of case management

Module Objectives

Module 1: Novice to Expert Case Management Roles (CNS)

  1. Compare and contrast the role of the case manager for the novice versus the expert.
  2. Identify case management model(s) which guides your practice of case management.
  3. Analyze a case study involving legal responsibilities of the case management professional.
  4. Analyze a case study involving ethical responsibilities of the case management professional.

Module 2: Case Manager Procedures

  1. Compare and contrast Points of coverage (VA vs military)
  2. Overcome barriers to access services and supplies.
  3. Develop efficient work flow patterns.
  4. Adopt techniques in evaluating client/consumer outcomes and redirecting care.

Module 3: Case Manager Administration

  1. Discuss financial considerations in case management administration.
  2. Review quality assurance reporting procedures associated with case management.
  3. Describe factors in the development of a case management team..

Module 4: Trends & Opportunities

  1. Discuss several emerging issues which have an impact on case management
    1. Multi-Cultural and Health Behavior
    2. E-Health
    3. Tele-health
    4. Aging Population
    5. Genetics and Biotechnology
  2. Discuss the role of Global Case Management/Care Coordinators

Module 5: Case Analysis of Issues

  1. Analyze the following populations using case management principles:
    1. Traumatic Brain Injury / Mild TPI
    2. Amputations
    3. PTSD
    4. Burns
    5. Spinal Cord Injury
    6. Low Back Pain
    7. Hearing
    8. Sight
    9. Oncology
    10. HIV/AIDS
  2. Describe the role case management plans in the process of death and dying.
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