• Karen McPhail, RN, MSN

Why It Is Beneficial for Service Providers To Collaborate with Care Managers



Many general practitioners, geriatricians, care communities, and other service providers spend extensive time on non-billable patient management and communication. Having a collaborative partnership with a care manager can often be the answer to many clinical management challenges and lead to better outcomes and patient satisfaction.


What can a Care Manager do?

  • Assisting to streamline communication by serving as a liaison and primary point of contact for all involved parties.

  • Providing individualized 24 hour, 7 day a week access to clinical guidance, support, and care management services.

  • Management of challenging patient / family dynamics allowing other clinicians to focus on providing quality care within the scope of practice.

  • Clinical care management, facility care plan meeting participation, at home customized care plans, and interdisciplinary care coordination to support better compliance with care regimes and quality outcomes.

  • Proactive approaches to clinical management to prevent falls, hospitalizations, and impact quality and holistic wellness.

  • In depth, customized cognitive evaluations and recommendations using BCAT system and other diagnostic tools. Behavior Modification Assistance adn caregiver education and support.

  • Strategic long term care planning to ensure clinical needs met long term based on expressed wishes.

  • Connecting patients with appropriate and cost effective resources as needed and utilization of appropriate entitlement programs to minimize costs and maximize services and quality.

  • Assisting with mental health and adjustment issues based on changes in medical condition, the need for care at home, or in a care community.

  • Alternative living coordination and relocation assistance to ensure proper fit based on care needs, budget, and patient wishes. Assitance with aging in place and at home assisted living.

  • Advocacy services for older adults and those in need.

  • Assisting with transportation, expedited testing, and consults,

  • Entitlement program guidance and benefits and insurance review.

  • Socialization support, pet visits, and out of state / distant family care management.

  • Care coordination for complex disease processes.

  • In facility collaboration and quality of care reviews, and more…

Care Managers work in collaboration with physicians, hospitals, discharge planners, elder care law attorneys, individuals & families impacted by acute, chronic, or degenerative conditions, banks & trusts, guardians & powers of attorney, senior communities, rehab facilities, home health agencies, PT, OT, speech, nutrition, hospice organizations, adult protective services, adult & child daycares, mental health professionals, community outreach programs, & social workers. 

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