Certificate Program in Advanced Case Management: Perfecting Transitions of Care in Healthcare Reform
This advanced level case management certificate program will focus on the essential role the case manager will play in healthcare reform in collaboration with other healthcare professionals. Healthcare Reform brings with it, a wide-range of new skills and perspectives for the case manager. This course will introduce and explain all aspects of these evolving case manager skills and successful care delivery strategies, ranging from transitions in care, cross continuum committees to readmission prevention. In addition, the most recent evidenced-based literature on healthcare reform, particularly for complex populations, will be discussed in relationship to each type of healthcare facility and levels of care. Aspects of healthcare reform have been associated with enhanced penalties to hospitals and other care providers. This course will also update participants on the current status of audits and penalties, while teaching the updated case manager skills required to prevent, appeal and overturn denials. Real-life clinical experiences will be used to facilitate group discussions and a detailed analysis of case studies to ensure application to the participant's work setting. Emphasis will be on the case manager's role in meeting the health care quality agenda, ensuring financial performance, and effectively implementing health reform in care coordination, care transition, and case management activities.
Through successful completion of this certificate program you will be able to:
- Describe the case manager’s new and evolving role in healthcare reform and the evidenced-based care strategies that cross the continuum which are proving successful in the delivery of best, quality of care.
- Explain the importance of "transitions in care" strategic initiatives, in relationship to health care reform and the Affordable Care Act.
- Relate the history of the Medicare Program and the changes required to support Healthcare Reform.
- Discuss the new penalties and auditing programs impacting hospitals and potentially other levels of care, such as the Recovery Audit Contractors (RAC) and Pre-payment audits (MAC).
- Thru case studies, develop a transition of care plan that crosses the healthcare continuum and is co-managed by multiple healthcare providers
Day One: Update on HealthCare Reform and the Affordable Care Act: Explanation of rules/laws, impact on patient care and the evolving case management role
Day Two: Description of “Evidenced-based Strategic care Initiatives” and how to implement across the Care Continuum. Each lecture will provide the details of each strategy and the case manager skills necessary in order for a case manager to implement into their own patient care setting.
Day Three: Financial implications of healthcare reforms for hospitals and other healthcare settings, reviewing all the new audits and penalties. Participants will be taught how to understand and maneuver through the new penalties and the manner in which to audit/overturn denials in the best interest of their facility. A large focus of this day will be on compliance and quality of care.
Day Four: Application of new case management skills is the main focus of this day. Sharing and explanation of the multiple clinical tools which are necessary to implement the best practice in healthcare reform. This day’s discussions include readmission avoidance programs, community-based case management, Medical Home Program’s and Meaningful Use Measures.
This program is designed for:
- Case managers with an RN, SW or other professional degree who want to learn about the newest advances in healthcare reform and their evolving role Nurses and other healthcare professionals who want an update in healthcare reform and the Affordable Healthcare Reform.
- Healthcare Managers and Administrators seeking an understanding of the case manager’s role and other critical issues associated with healthcare reform.
This is an advanced course:
- Participants must have management experience and/or be a healthcare provider involved in the transition of care of patients across the continuum of care. Completion of the USM Case Management Certification Course proves a benefit but is not required.
This program is offered during the Spring semester only. This program is four full day class meetings (6hrs per class meeting).
4 Fridays: March 29th, April 26th, May 24th, and June 14th
$625 (Includes all course materials)
24 contact hours/ 2.4 CEUs
- June Stark, RN, BS., M.Ed., is director of case management, quality support services at Tufts Medical Center in Boston, and an associate consultant for The Center of Case Management in Natick, Massachusetts.