Case management is a process of coordinating an individual client's total health care services to achieve optimal, quality care delivered in a cost effective manner. The process integrates assessment, planning, implementation, and evaluation components. Occupational health nurses as case managers provide all or a portion of these services in addition to the coordination effort. Based on the complexities of health care and business environments, case management services must be delivered by qualified health care professionals with sufficient knowledge and expertise to perform this important function competently. Skyrocketing increases in basic health care premiums and workers' compensation costs have forced employers to focus on cost containment strategies.
Many corporations now offer their employees health benefit plans that include managed care options.
In a climate with an increasing focus on managed care, the case management function is valuable to the employer and insurance payers. Today's proactive practitioners should be cognizant of the client's needs and desired outcomes, the employer's priorities and focus on cost containment strategies, and the many service options available. Effective case management is one method that enables employers not only to quantify their health care costs but also to quantify savings through coordination of services.