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Source: CMSA Today As case managers, we have the privilege and responsibility of serving individuals, families, caregivers, and communities during some of the most vulnerable moments of their lives. Despite the ever-changing healthcare landscape and the challenges that continue to shape our profession, our commitment remains unwavering: to improve the health and well-being of those

Source: CMSA Today BY MICHAEL B. GARRETT, MS, CCM, CVE, CPCHE Utilization management, also called utilization review, has been present in the U.S. healthcare system for several decades. Initially, utilization management programs were focused on addressing overutilization, meaning excessive use of healthcare services that lead to waste in the system without realizing significant improvements in

Source: CMSA Today BY DR. COLLEEN M. MORLEY, DNP, RN, CCM, CMAC, CMGT-BC, ACM-RN, FCM, FAACM As healthcare continues to evolve toward value-based care, the expectations placed on case managers — particularly in utilization management (UM) — have grown significantly in both scope and complexity. Today’s case manager is no longer simply coordinating care; they

Source: CMSA Today BY PAUL BORJA, RN, PHN, DHA, DNP, EdD, DBA, PhD, CCM, ACM, CMAC, CNML, CMGT-BC, CMCN, CDONA, FAACM, FACDONA, FSIEN, FADLN INTRODUCTION Healthcare delivery has evolved considerably over the past two decades due to advances in technology, regulatory changes, value-based reimbursement, and increasing patient complexity. As healthcare systems become more interconnected, case

Source: CMSA Today BY AMANDA WARD, BSN RN After a new diagnosis or hospital admission, patients and caregivers can often feel a wide range of emotions. Anxiety over new challenges at home or work due to their illness. Concern about their prognosis, new or future limitations, or financial and social strain due to demands of

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

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