Artificial Intelligence and Innovation in Case Management Nursing

Source: CMSA Today BY HEATHER KELLY, MSN, RN, BCPA, CPC Case management nurses operate at the intersection of clinical care, utilization management, and patient advocacy. As healthcare systems become more complex, case managers are increasingly tasked with managing high-risk populations, coordinating care across settings, and addressing social and behavioral determinants of health, all while navigating […]

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Life Care Planning for Healthcare Professionals: An Overview

Source: CMSA Today BY ANNE GOWING, RN, CRRN, CNLCP®, MSCC, FIG MCP-C, FIG LCP-C INTRODUCTION As healthcare grows increasingly complex, so too does the need for professionals who can provide comprehensive, forward-looking life care plans for individuals with chronic illness, catastrophic injury, or disability. Life care planning is a specialized discipline integrating medical, vocational, and

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Peanuts and Case Managers

Source: CMSA Today BY MICHELLE BRUSIO, MSN, RN, CCM One of my favorite guilty pleasures is collecting and enjoying Charles Schulz’s Peanuts. From the earliest comic strips to the beloved television specials and treasured collectibles, some classics truly stand the test of time. Each character was inspired by someone in Schulz’s life, and together the

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Every Heart Matters: Empowering Underserved to Manage High Blood Pressure

Source: CMSA Today BY HEIDI STEINHEBEL, RN BSN CCM Hypertension impacts Black African Americans 26% more often than other racial/ethnic groups, and approximately 83% of Black adults with high blood pressure do not have it under control, even while on medications. Deaths related to high blood pressure occur twice as frequently in Black Americans compared

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The Human Algorithm: Integrating Artificial Intelligence (AI) into Professional Case Management Practice While Upholding the CMSA Standards of Practice

Source: CMSA Today BY CATALINA KHALAJ, PMHNP-BC, MSN, RN, CCM, ACM, CMGT-BC—A case manager with experience across ambulatory care, acute care, managed care, and population health. ABSTRACT In an era of unprecedented technological advancement, professional case managers stand at the intersection of innovation and compassion. Artificial intelligence (AI) and digital tools offer powerful capabilities to

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Beyond the Authorization: Navigating the Evolving Challenges of Utilization Management

Source: CMSA Today BY JANET COULTER, MSN, MS, RN, CCM, FCM INTRODUCTION Mention utilization management (UM), and many healthcare professionals immediately think of prior authorizations, medical necessity reviews, documentation requirements, and coverage determinations. It may not be the most glamorous area of healthcare, but utilization management sits at the very heart of ensuring patients receive

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ACCESS and the Future of Chronic Care: CMSA Helps Define the Role of Case Management

Source: CMSA Today When the Centers for Medicare & Medicaid Services (CMS) introduces a new care delivery model, healthcare organizations begin asking how they’ll implement it. CMSA asked a different question: Where does professional case management fit? That question inspired the development of CMSA’s new position paper, Advancing Chronic Care with Effective, Scalable Solutions (ACCESS)

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The Heart of Leadership

Source: CMSA Today BY JANET COULTER, MSN, MS, RN, CCM, FCM There are moments in life when you accept an opportunity knowing it will challenge you. Then there are moments that change you forever. Serving as president of the Case Management Society of America has been one of those moments. When I accepted the privilege

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Interdisciplinary Teamwork Using Care Coordination and Integrated Case Management (CCICM): The Key to Breaking Traditional Health Care Silos

Source: CMSA Today BY ANGELA SIMMONS, MSW, LCSW, CCM AND BINA STITT, MPA, MSN, RN, CCM Back in 2016, two major VA offices— Offices of Nursing Services (ONS) and Care Management and Social Work (CMSW)—teamed up for something big: the Integrated Case Management Initiative. The goal was to take a hard look at how we handle

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Internal Authorization, External Impact: A Case Management Innovation to Reduce Length of Stay and Improve Throughput

Source: CMSA Today BY COLLEEN MORLEY, DNP, RN, CCM, CMAC, CMGT-BC, CMCN, ACM-RN, FCM, FAACM Delays in payer authorization for post-acute services remain one of the most persistent—and often underappreciated—drivers of prolonged hospital length of stay (LOS). While clinical teams may achieve medical readiness for discharge, patients frequently remain hospitalized due to administrative barriers outside of

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