Case management is an approach to coordinating care for individuals in the health, mental health, or social welfare systems. The term can be used to describe the coordination of care and services within the insurance industry, but can also describe an approach to connecting medical and mental health patients with community and health care resources. The goal of case management is to ensure that individuals who need care receive it and that insurance, medical, and social resources are used efficiently.
Many individuals who have a need for health care services, particularly mental health care services, require assistance that goes beyond the scope of what medical and mental health care systems can offer. It is often crucial to the well-being of a patient, however, to ensure that he has a place to live, food to eat, and appropriate care at home. Without these supports, the efficacy of health care can be undermined, sometimes to the point where it is ineffective. Case management provides vulnerable patients with a point person who can connect the patient with community resources and family in hopes of better understanding his situation and needs. Depending on the patient's situation, either the health care setting or an outside agency may provide a patient's primary case management services.
Case management services are provided by individuals who typically have training either in the medical or social work fields. Many medical case managers are nurses, though some are social workers. In social service agencies, case managers may also be social workers, though some may not hold any particular mental health credentials. In some countries, such as the United States, it is possible for a case manager to acquire certification through a professional society for case managers.
In the health insurance and managed care industries, a case manager can work with individuals who have serious health problems to make sure they are getting appropriate, cost-effective care. The case manager can work with service providers to settle appropriate rates and payments for services, refer the client to specialists, and help the client make decisions about her care. Some health insurance companies routinely appoint case managers to policy holders with serious or chronic conditions. Employers may also use the services of case managers who can help the organization work with employees who have long-term medical needs and who can support employees in caring for themselves as well as insuring that the organization can make proper accommodations for the employee's needs.