Ambulatory Case Management

Masters Degree in Case Management

CSM 725

Breyer State University
Instructor: Mary Lyn Page, RN, MSN

SYLLABUS

COURSE OVERVIEW: This course is designed to focus on the role of the case manager in ambulatory care settings. The course work will include the study of the general role of the case manager, the insurance environment, legal and ethical responsibilities, communication, work format, consulting, credentialing, and future trends. After successful completion of the course, the student will possess solid knowledge about the role of the case manager.

This course is a graduate level course and is formatted to be self-directed. As your instructor, I am available for one-on-one consultation. Methods of communication between us can be via email and telephone appointments. The course completion time limit follows the university’s policy of not less than four weeks and not to exceed ten weeks.

Course work required for successful completion is comprised of a midterm and a final exam. The midterm is expected to be taken by the 5th week and the final exam is expected to be completed by the 10th week.

TIME FRAME: This is a five-semester hour course. This course is allotted ten weeks of time. You must complete all the requirements for the course successfully by the end of the ten-week period. The first day of week one will begin the day that you register for the course, or the day, which you notify me that your textbook(s) have arrived and you are ready to begin your studies. Please be cognizant of the time frame. It is rare that extensions of tie are permitted, unless the student has good justification. Upon successful completion of this course, you will be awarded five semester hours of credit.

TEXTBOOKS: The following book is required for this course.

Book 1: The case manager's handbook. (3rd ed.). Mullahy, C. M. .Gaithersburg, MD: Aspen Publishers, Inc: 2004. ISBN # 0-7637-3188-9.

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GRADING SCALE: The midterm and final are weighted equally.
You will receive a letter grade based on your overall achievement. The grading scale is as follows:

90–100%    = A
80–89%      = B
70–79%      = C
Below 70%  = Fail

COMMUNICATION: Best way to reach me is by e-mail. Otherwise you can make an appointment for a phone conference.

ABOUT YOUR INSTRUCTOR: Currently, medical case manager for Zurich American Insurance. Other positions have included staff nurse at several NYC hospitals, utilization review, hospital bill auditing, and staff development for case management organizations. I have a BSN from Skidmore College and an MSN from the University of Phoenix. My present position requires working closely with injured workers and their families throughout rehabilitation and recovery with assistance in job accommodation upon referral from insurance carriers.

COURSE OBJECTIVES: Upon completion of this course, you will be able to:

1). Identify a case manager's role and function.
2). Identify the range of people that case managers work with.
3). Identify the significant types of insurance providers and administrators.
4). Identify the types of insurance lines and health benefit plans.
5). Identify the legal and ethical responsibilities of the case management profession.
6). Define the elements of strong communication skills.
7). Identify the components of case management: assessment, coordination, planning, monitoring, implementation, and evaluation.
8). Explain the process of integrated case management: preadmission, concurrent, and utilization review.
9). Define the importance of the case manager-claims department relationship.
10). Identify future trends in case management.

INFORMATION: If you have any questions regarding this program, you may address them to adm@breyerstate.com. An administrative faculty member will respond to all questions.

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