By Suzanne K. Powell RN BSN CCM;Donna D. Ignatavicius MS RN Cm

ISBN-10: 0781779170

ISBN-13: 9780781779173

This textual content comprises the center physique of information for case administration perform as delineated via the Case administration Society of the United States (CMSA), the biggest specialist association of case managers. The middle curriculum presents a "synthesis of case administration evolution," and provides crucial parts, thoughts, and imaginative and prescient for present and destiny case administration perform. This version is considerably improved to mirror the dynamic adjustments happening in case administration. every one bankruptcy is prepared in a constant layout that incorporates studying targets; creation; vital phrases and ideas; key definitions; and references.

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Health care and disability-related legislation f. Interpersonal communication g. Legal and regulatory requirements h. Risk management i. Standards of practice 3. Psychosocial and support systems a. qxd 02/02/2007 10:22 Page 15 TechBooks [PPG Quark] HISTORY AND EVOLUTION OF CASE MANAGEMENT 15 b. Psychological and neuropsychological assessment c. Management of clients with substance use/abuse/addiction d. Wellness and illness prevention concepts and strategies e. Community resources f. Support programs g.

Patients may not seek care of specialist providers without a referral or authorization from the PCP. ii. Co-pay is less than that of an open panel model. B. Preferred provider organization (PPO) 1. An insurance structure in which contracts are established with providers of medical care. 2. Providers under a PPO contract are referred to as preferred providers. 3. Usually the contract provides significantly better benefits for services received from preferred providers, thus encouraging members to use these providers.

4. Provider follows government rules and regulations for these payment groups; that is, at a minimum, providers must offer the same services offered under the government plans (mainly Medicare and Medicaid). 5. Plan assumes risk for member, who relinquishes traditional coverage (either voluntary or assigned, depending on state regulations). M. Third party administrator/administration (TPA) 1. Administration of a group insurance plan by some person or firm other than the insurer of the policyholder 2.

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CMSA Core Curriculum for Case Management by Suzanne K. Powell RN BSN CCM;Donna D. Ignatavicius MS RN Cm

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