Best Practice Case Management Roles and Functions: How to Optimize RN and Social Worker Skill Sets
Toni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models, educating case management professionals and assisting in the implementation of case management departmental changes. The author of nine books and a frequently sought after speaker, lecturer, and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management. Dr. Cesta writes a monthly column called “Case Management Insider” in the Hospital Case Management journal in which she shares insights and information on current issues and trends in case management.
Prior to her current work as a case management consultant, Dr. Cesta was Senior Vice President – Operational Efficiency and Capacity Management at Lutheran Medical Center in Brooklyn, New York. She was responsible for case management, social work, discharge planning, utilization management, denial management, bed management, the patient navigator program, the clinical documentation improvement program, and systems process improvement. Dr. Cesta has also held positions as Corporate Vice President for Patient Flow Optimization and Director of Case Management. She also designed and implemented a Master’s of Nursing in Case Management Program and Post-Master’s Certificate Program in Case Management at Pace University in Pleasantville, New York. Dr. Cesta completed seven years as a Commissioner for the Commission for Case Manager Certification.
This session will discuss the roles and functions of staff in a case management department that are needed to support the department’s goals through collaborative professional processes. The skill sets and characteristics for the role of the RN case manager and the social worker will be reviewed, as well as identifying the most contemporary functions needed to respond to changes brought on by healthcare reform and public reporting of healthcare data. It is the challenge of every case management department to determine how to optimally use these valuable resources and knowledge to achieve positive and sustainable outcomes. Integration of these professionals has also been shown to improve patient satisfaction. Through appropriate design, each discipline’s unique talents can be best optimized, also enhancing their own personal job satisfaction. This program will also discuss methods for identification of patient assignments, staffing ratios, rounding and other practical strategies for successful integration of these two vital roles.
Case management models have continued to evolve over the past 25 years and with that evolution, the roles of the RN case manager and social worker have also evolved. Early models of acute care case management were designed without integrating or clearly defining the roles and unique skill sets of each discipline, This resulted in role confusion as well as less than adequate use of each discipline in their contributions to the case management team. Clearly optimizing each discipline’s educational preparation allows them to work ‘at the top of their license’. As the roles of each discipline have been more clearly defined, each professional can enjoy greater satisfaction and improved outcomes in their daily practice.
- Discuss the key roles and functions of the nurse case manager and social worker
- Review the daily workflow for each discipline, including the identification of high-risk patients for referral to the social worker
- Describe the best ways to optimize the unique skill sets of each discipline to achieve effective outcomes
- Identify the impact these two groups of professionals can make on a case management department’s outcomes
Who Should Attend
- Director of Case Management
- RN Case Managers
- Director of Quality Management
- Director of Social Work
- Social Workers
- Physician Advisors