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Case Management

Case Management

Improves quality and reduces costs through timely discharge planning, alternative treatment options and negotiated rate reductions.

Case Managers are accredited registered nurses who function as advocates, facilitators and educators, assuring that members make smooth transitions from inpatient settings to step-down facilities and home when appropriate. Other programs such as Utilization Management, Beyond Disease Management and Care Line (24/7 Demand Management) help facilitate early identification and notification to Case Management, resulting in significant savings. Case Management affects health care costs through:

  • education of patients and families on alternatives to costly inpatient care;

  • negotiation with caregivers to provide service at cost effective rates;

  • coordinating services to assure the smooth transition from hospital to step-down units and home care alternatives.
Key Features & Advantages:

  • Case Management programs are accreted by the Utilization Review Accreditation Commission (URAC).

  • Case Managers have a minimum of 5 to 8 years clinical experience and prior medical or case management background with certifications in case management, rehabilitation or other specialty areas.

  • Case Manager specialties include:
    • Medical/Surgical
    • Oncology
    • Rehabilitation
    • Cardiac
    • Maternity/Newborn
    • Pediatric
    • Transplant
    • Psychiatric/Substance Abuse

  • Among the advantages of utilizing Case Management Specialists are:
    • greater access to centers of excellence or specialty care facilities
    • greater discounts
    • understanding of specialized care strategies

  • In addition to making use of their own expertise, the Case Managers have access to a Medical Director and full-spectrum specialty physician panel.

  • The Case Management program features online integration Utilization Management and Care Line (24/7 Demand Management).

  • The Case Managers work hand-in-hand with Interactive Medical Systems and reinsurance carriers to provide timely and on-going information on these high-cost cases, while maintaining appropriate confidentiality in keeping with HIPAA regulations.
Interactive Medical Systems clients benefit from the dedicated effort of specially trained personnel to expedite the transition from hospital to step-down alternatives. Costs are reduced, quality of care is maintained.