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Case Management Boot Camp 2023!

Recorded Session | Toni G. Cesta | From: May 09, 2023 - To: Dec 31, 2023
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Course Description

The world of healthcare is changing rapidly and so is the role of case management in that world! Whether you are reading or hearing about value-based reimbursement, the Affordable Care Act, the continuum of care, bundled payments, transitions in care, or accountable care organizations, case management is at the center of it all!

Because things are changing so rapidly it can be a challenge to stay current and knowledgeable in the issues that most greatly impact your role as a case manager. Reimbursement has changed dramatically as has utilization management, transitional planning, and length of stay management. CMS has incorporated changes that impact payments related to readmissions, length of stay, and the cost of care. Who is in a better place to address these issues than case managers? Finally, how do all these roles come together in a cohesive way that meets the needs of your department and your organization?

All these topics and more will be covered in this jam-packed five-part series. Webinar 1 will start the series with some of the fundamental issues pertaining to case managers, including reimbursement systems, the history of case management, and common trends in the field. The next three webinars will review the three most imperative roles for acute case managers.

The first, in Webinar 2, will be a discussion of the role of utilization management, including rules, regulations, and strategies for incorporating utilization into your daily routine.

Webinar 3 will provide insights and up-to-date information on the role of discharge planning including new rules instituted in 2020.

Webinar 4 will provide an in-depth review of care coordination, a vital, but often forgotten role for hospital case managers.

We will end our series with Webinar 5, a discussion of how to integrate the roles and functions we have reviewed as well as a comparison of two state-of-the-art case management models. You will learn about the complimentary, but separate roles of RN case managers and social work case managers.

Whether you are new to case management or a seasoned pro, this webinar series will provide you with the latest and most up-to-date topics and information that you will need to be at the top of your game and produce the best outcomes for you, your patients, and your organization.

Foundations for Case Management Practice in 2023 and Beyond! Part-1

90 Minutes, 11:00 AM EST (May 09, 2023)

  • The environment in which we work
  • The healthcare industry today
  • The mandate for change
  • Healthcare costs
  • Managed care
  • The link between cost and quality of care
  • Medicare’s new tools
  • The Patient Protection and Affordable Care Act
  • Value-Based Program Measures
  • Medicare Spending for Beneficiary
  • Case management strategies to offset reimbursement reductions
  • The Hospital Consumer Assessment of Healthcare Providers and Systems Hospital Survey
  • Hospital Readmission Reduction Program
  • Accountable Care Organizations
  • The evolution of case management
  • Case management – what it is and what it will become


Case management began moving into acute care settings around 1985 following the introduction of prospective payment. Today case management is found across the continuum of care, most recently returning to the community where its roots began. This program will review where case management came from and how it will work in today’s managed care and government-payer environments. Included will be a review of Medicare’s latest programs that impact the role of the case manager most directly including value-based purchasing, the readmission reduction program, accountable care organizations, and others. Take a glimpse into the future in this state-of-the-art review.


After this webinar attendees will be able to:

  • Understand the history of case management
  • Review how case management fits into today’s healthcare system
  • Discuss the ways in which case management is a strategy for managing cost and quality under the latest CMS reimbursement models

Utilization Management: Rules, Regs and How To’s Part-2

90 Minutes, 01:00 PM EST (May 09, 2023)

  • Utilization management definition
  • Difference between utilization review and utilization management
  • Medical necessity defined
  • UM processes for, and components of, medical necessity
    • When a patient meets medical necessity
    • When a patient does not meet medical necessity
  • Compliance components of medical necessity
  • Conditions of Participation by CMS and utilization management
  • Essential case management department activities
  • Utilization management and billing
  • Utilization management and reimbursement
  • Best practice in clinical reviews
  • Managing utilization from the bedside
  • Appropriate UM documentation
  • Physician collaboration in utilization management
    • Practicing physicians
    • Physician advisor
    • Utilization Management Committee physicians
  • Incorporating UM into your daily routine
  • Managing denials before they happen
  • UM documentation sources
  • Utilization management separated from the case management function


Utilization management was the first role applied in acute care case management models. It was first known as utilization review but has evolved into something much more comprehensive than that. Today it encompasses elements of resource management and denials management as well. Physicians, both the practicing physician and the physician advisor are often left out of this important process and must be included in any contemporary case management utilization management model. This program will review the role of utilization management as it applies to today’s contemporary case management models. Included will be best-practice suggestions for your practice with tips and strategies for streamlining the process and making it as efficient as it can be. Additionally, discussed with be the importance of utilization management collaboration in the case management role, whether it is housed with the RN case manager role or outside of it.


After this webinar attendees will be able to:

  • Describe the differences between utilization review and utilization management
  • Discuss the best strategies for managing utilization reviews and other issues related to utilization management
  • Identify ways in which a strong utilization management process can reduce payment denials

Discharge Planning: Best Practices Including a Review of the Conditions of Participation Part-3

90 Minutes, 03:00 PM EST (May 09, 2023)

  • CMS’s discharge planning rules
  • Case management transitional and discharge planning
  • Admission assessments
  • Social work triggers
  • Home care triggers
  • Influences on discharge planning
  • Latest changes in discharge planning from CMS
  • Communicating across the continuum of care
  • Next level of care providers
  • Hand-off communication
  • The interdisciplinary impact on discharge planning
  • Transitions time-outs
  • How to hard-wire your processes


Discharge planning has become more than just the movement of the patient out of the hospital. It is a “process” that starts at the point of admission and follows beyond discharge and through the continuum of care. The Centers for Medicare and Medicaid Services have proposed more “teeth” to the process, with updates to the discharge planning section of the Conditions of Participation. This program will review the most recent reimbursement challenges from the Medicare program as well as strategies for safely transitioning your patients across the continuum of care. Effective discharge plans can improve your hospital’s value-based reimbursement. We will review how to engage other members of the interdisciplinary care team in the process of planning for the patient’s movement across the continuum including verbal and written hand-off communication. Discharge planning is no longer a destination but a process! Learn how to be certain that your processes address the complexities of the new healthcare environment.


After this webinar attendees will be able to:

  • Understand discharge planning as a process, not an outcome
  • Discuss the new CMS changes related to transitional and discharge planning and how they can impact your practice
  • Identify best practice strategies for transitioning patients across the continuum of care

Care Coordination: Managing Cost and Length of Stay Part-4

90 Minutes, 01:00 PM EST (May 12, 2023)

  • How to incorporate case management into your daily practice.
  • Care coordination’s impact on the length of stay and cost
  • How to measure the cost of care
  • Defining value in healthcare
  • Negative impacts on care coordination
  • Positive impacts on care coordination
  • Five key elements of care coordination
  • Strategies for evaluating your hospital’s own areas of inefficiency
  • Effective time-out processes
  • Rounds and huddles


You may spend most of your day focusing on utilization management and discharge planning, but care coordination is one of the key roles that hospital case managers and social workers perform. Other roles include utilization management and discharge planning. It is integral to managing cost and length of stay. Nevertheless, it is often overlooked or under-performed. This is sometimes due to workload issues and/or understaffing. Other times it is due to a lack of focus on this area of work.

This program will review the elements that most greatly impact cost and length of stay. By focusing on care coordination as one of the key strategies for successful reductions of these metrics, you will be better positioned to perform your role as a hospital case manager. Care coordination, as one of the main roles of the RN case manager, is complex and includes many characteristics that encompass the role. Although these issues can be complex, there are tools and techniques to incorporate care coordination into your daily practice. These will be covered as well as those elements that have the greatest negative impact on care coordination. Those that have the greatest positive impact will be discussed in detail. Working with teams to enhance care coordination, as well as rounds and huddles, will be discussed. Participants will walk away with effective strategies for managing their hospital’s length of stay and cost.


After this webinar attendees will be able to:

  • Understand the key elements of effective care coordination
  • Discuss ways in which to incorporate care coordination into your daily workflow
  • Identify how care coordination can be de-railed and how you can keep it on track

Acute Care Case Management: Roles, Functions, and Models Part-5

90 Minutes, 03:00 PM EST (May 12, 2023)

  • Contemporary case management roles
  • Contemporary case management functions
    • Patient flow
    • Utilization and resource management
    • Denial management
    • Variance Tracking
    • Transitional and discharge planning
    • Quality management
    • Psychosocial assessment and counseling
  • Integrating case management roles
  • The case management process
  • Social work role in the contemporary model
  • Evolution of case management models
  • Determinants of case management models
  • The Impact of Roles and Functions on the contemporary case management model
  • Model comparisons
  • Advantages of each model
  • Disadvantages of each model


As case management moved into acute care settings the roles and functions of both RN case managers began their evolution. From the time of the UR specialist sitting in the corner of a nursing station reviewing a record for medical necessity to appease the state physician review organization to the current role of the RN case manager involved in multidisciplinary collaboration, the roles have changed significantly.

This program will review the contemporary roles of both RN case managers and social work case managers, in addition to clerical support and more complex case management roles, such as the complex discharge planner. Evaluate your roles and functions, as well as the roles and functions of your department in this informative seminar.

As case management roles and functions evolved, so did case management models. From a model with social work support to a model without that critical support, case management leaders and hospital executives have been challenged to ensure a best practice model that lends itself to the most optimal outcomes.


After this webinar attendees will be able to:

  • Describe the different skill sets and roles of RN case managers and social work case managers.
  • Review specialty case management roles and determine new or updated roles for your contemporary case management department.
  • Understand the evolution of case management models
  • Identify the best model to ensure a contemporary case management department.

This webinar benefits the following:

  • Hospitals
  • Health Care Systems
  • Departments of Case Management
  • Departments of Social Work

Who Should Attend?

  • RN Case Managers
  • Social Workers
  • Directors of Case Management
  • Directors of Social Work
  • Physician Advisors
  • Vice Presidents of Case Management
  • Discharge Planners
  • Utilization Managers