Role of Case Managers in Hospital Admission and Hospitalization

Core Functions of Case Managers During Hospitalization

The American Academy of Pediatrics recommends that case managers conduct needs assessments for patients entering the hospital system, identifying appropriate levels of care and resources required 1, 2
Case managers facilitate the admission process by coordinating with insurance carriers for necessary authorizations and ensuring safe transport to the hospital, as suggested by the American Academy of Pediatrics 3
The American Academy of Pediatrics also recommends that case managers help direct patients to the most appropriate inpatient setting based on their specific medical problems 3
Case managers integrate and coordinate input from all physicians and ancillary providers when multiple specialists are involved in patient care, as recommended by the American Academy of Pediatrics 3
They facilitate communication between the healthcare team and patients/families to improve coordination of daily care plans, leading to fewer misunderstandings, according to the American Academy of Pediatrics 3

The American Thoracic Society recommends that case managers assess the needs of patients and families for resources and support 4, 5, 6
They develop and coordinate care plans that address identified needs across medical, psychological, functional, and social domains, as suggested by the American Thoracic Society and other guidelines 2, 4, 5, 6
Case managers monitor and evaluate service provision and costs to ensure appropriate resource allocation, according to the American Thoracic Society 4, 5, 6
The American Geriatrics Society recommends that case managers coordinate services across multiple providers and settings, including hospital, home, and community 4, 5, 6
They serve as patient advocates, ensuring patients receive appropriate services and have their needs met, as recommended by the American Geriatrics Society 4, 5, 6
Case managers help control unnecessary utilization and costs while ensuring quality of care, according to the American Geriatrics Society and other guidelines 7, 2

The American Thoracic Society recommends that medical case management focuses specifically on coordinating the healthcare team for patients' medical needs 4, 5, 6
Comprehensive case management addresses broader aspects beyond medical needs, including financial, psychosocial, and educational needs, as recommended by the American Thoracic Society 4, 5, 6
This approach promotes the patient/family's role as primary decision-makers in their care, according to the American Thoracic Society 4, 5, 6

The American Geriatrics Society recommends that case management has been shown to increase services and reduce unmet needs for patients 7, 2
It increases patient confidence in receipt of care and improves life satisfaction, according to the American Geriatrics Society and other guidelines 7, 2
Case management interventions have demonstrated reduction in COPD-related hospitalizations, as recommended by the American College of Chest Physicians 8

The American Geriatrics Society recommends that potential conflicts of interest may arise when the case manager is also a service provider 7, 2
Funding for case management services is often neither uniform nor fair, creating a confusing array of service providers and eligibility requirements, according to the American Geriatrics Society and other guidelines 7, 2
Case management is most effective when a single individual is designated to manage coordinated care over time, avoiding fragmentation, as recommended by the American Thoracic Society 4, 5, 6

The American Thoracic Society recommends that case managers have clinical expertise, community awareness, and strong communication skills 4, 5, 6
The American Academy of Pediatrics suggests that family-centered care should be promoted by involving patients and families in decision-making processes 3, 2