Case Management Leadership (Part 1)

Why Should You Attend:

The role of the leader is challenging. Understanding priorities for managing a best-practice department is the goal of each case management leader. Priorities range for compliance, to mentoring staff—both experienced and novice, and to outcomes. This webinar will assist the leader in understanding priorities and the most opportune way to implement best practice in their department. It will also enable the leader to understand true collaboration, with physicians, physician advisors, payers and other care providers in the hospital. Developing a strategy for the future, including understanding the potential role of artificial intelligence in the case management department will be discussed.

Areas Covered in the Webinar:

• Part 1: What is leadership?
• The role of the leader versus the role of a manager
• Leadership traits Leadership and value-based reimbursement
• Challenges of case management leadership
• Develop a best practice case management model
• Best-practice roles
• Maintain appropriate operational focus
• Physician and physician advisor collaboration
• Ensure appropriate vertical and horizontal relationships in your organization
• Payer contracts

Who Will Benefit:

• Case management Leaders: Directors of Case Management, Directors of Utilization Management, Directors of Social Work, Managers and Supervisors of Case Management, Utilization Management and Social Work
• Executives to whom these leaders report

Beverly Cunningham
Consultant, Case Management Concepts LLC

Bev Cunningham, MS, RN, ACM is a founding partner of Case Management Concepts, LLC. She has a 25-year deep working knowledge of case management with specific expertise in denials management, patient flow and the role of the Case Manager and Social Worker in the Case Management process. Bev is also a certified case manager with the American Case Management Association. She has served as a Commissioner on the Commission for Case Management Certification and is a fellow with the Advisory Board. Bev is also the former Vice President of Resource Management at Medical City Dallas Hospital.

She has co-authored a book for hospital case managers—Core Skills for Hospital Case Managers and has written the utilization management chapter in the past two editions of CMSA’s book, Core Curriculum for Case management.

Topic Background:

The role of the case management leader is one of the most difficult positions in any healthcare setting. The attractive things about a leadership role in case management also makes it one of the most challenging. The implementation of value-based reimbursement by payers, starting with Medicare, sets the scene for a case management department that must straddle the reimbursement system—payment per contractual agreement, provider-risk payments (such as bundled payment), payment for value and combinations of each of these. Additionally, what Medicare does, other payers seem to follow. Case management leaders are expected to have a skill set that ranges from clinical knowledge and expertise, to knowledge of healthcare finances and reimbursement, to leadership and strong, effective management skills.

The case management leader’s leadership and management skills are critical for managing staff, departmental budget, ensuring compliance to state and federal regulations, staff management and development, and engagement in value-based reimbursement models. The combination of limited resources, coupled with an often-middle management role, and a requirement of a wide range of skills and knowledge, all add up to a complex and difficult job. In addition, the leader must stay current in all issues related to case management and often answer to senior leaders who do not completely understand the roles and value that case management can bring to an organization. With value-based reimbursement, the case management leader must not only ensure best practice operations for today, but also strategize for best practice operations for the future. What happens in case management outcomes today, is impacting potential value-based reimbursement penalties in the future.

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