Information about coverage and benefits must be included when developing the plan to ensure that patients are getting the most out of their insurance plan and that enough resources exist to carry out the plan. Case management plans should contain specific actions, including their steps, sequence, duration, and frequency. Many case managers specialize in a particular area and are quite knowledgeable. They rely on their expertise and experience to plan for each patient's unique characteristics and situation. Developing a plan that is agreeable to all parties requires skills in communication, negotiation, and collaboration.
Case managers check with providers to be sure certain services are available.
They check with payers to ensure services are covered and follow required guidelines for authorization. They also check with the family members who are expected to take an active role in providing care. Case managers use their knowledge of benefits, the healthcare system, the provider, and vendors to establish and implement a plan that is both comprehensive and practical, and to make recommendations based on solid cost-benefit analyses. Case managers facilitate and initiate action when needed, functioning as agents of change. They contact providers to discuss the plan and confirm providers' part in the plan.