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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 […]

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

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

Source: CMSA Today BY HEATHER KELLY, MSN, RN, BCPA, CPC A child’s eighteenth birthday marks an abrupt and consequential transition, not only socially but legally, transforming a dependent minor into an autonomous adult overnight. In healthcare, this legal reclassification can fracture continuity of care, abruptly limiting parental access to medical information, decision-making authority, and coordination roles

Source: CMSA Today BY JACQUELINE (JACQUI) BASTIAN, BSN, RN, MSOL, CCM, KATE COFFIELD AND AMY CAMPBELL-TUMBLIN EXECUTIVE SUMMARY In early 2023, OhioHealth and The Laurels Healthcare launched a direct-bill, contracted-bed model to safely transition medically stable, long-stay patients with significant discharge barriers from acute care to skilled nursing facilities (SNFs). Over three years, the partnership improved hospital throughput, protected

Source: CMSA Today BY HEIDI STEINHEBEL, RN, BSN, CCM Heart failure represents a significant national health crisis, accounting for more than one million hospitalizations annually in the United States. The condition affects approximately one in four individuals over their lifetime, with the prevalence expected to increase from 6.7 million Americans today to 8.5 million by 2030.

Source: CMSA Today BY AMANDA LEIGH LAW, RN, BSN, CCM AND HASEEN WILLIAMS “I can’t thank you enough for picking up that extra project; I know how busy you are.” “Wow, you’re working overtime this week, too? You’re so committed to your job!” These phrases, praiseworthy in nature, highlight the irony many health professionals frequently feel. In