By Chris Herman, MSW, LICSW

Case managers help provide an array of services to help individuals and families cope with complicated situations in the most effective way possible, thereby achieving a better quality of life. They help people to identify their goals, needs, and resources. From that assessment, the case manager and the client— whether an individual or a family — together formulate a plan to meet those goals. The case manager helps clients to find resources and facilitates connection with services. Sometimes she or he advocates on behalf of a client to obtain needed services. The case manager also maintains communication with the client to evaluate whether the plan is effective in meeting the client’s goals.

I’m not a “case”!

Case managers don’t manage people; they help people to manage complicated situations.

A good case manager will work with you to determine what is important to you and what you think would be the most effective way to reach those goals. They help to keep you, or your loved ones, at the center of services being provided on your behalf.

Care management and care coordination are two other terms sometimes used to describe this work. Different organizations and individuals define these terms in different ways; for example, professionals providing services to older adults often call themselves geriatric care managers. The terms case management and case manager are used in this article for the sake of simplicity, but the information also applies to care management and care coordination.

Where Do Case Managers Work?

Case managers work in a variety of specialties, including health care, mental health care, addictions, long-term care, aging, HIV/AIDS, disabilities, occupational services, child welfare, and immigrant/refugee services. They are employed in the public, nonprofit, and for-profit sectors.

What Kind of Training Does a  Case Manager Need?

Case managers come from a variety of professional backgrounds and disciplines — including social work, nursing, gerontology, to name a few. They need to understand how to both work with individuals and families and navigate complicated service systems.

Social workers, who are trained to help people in the context of their unique social environments, are distinctly prepared to offer case management services. In fact, the social work profession grew out of early case management work in the early  20th century, and social workers have remained active in case management since that time.

Certification is available in case management and specialty areas of practice, such as gerontology. Knowing that a case manager is  certified can help you to feel confident that you are working with a skilled, well-trained professional. Some workplaces require certification, but others do not. Social work case managers should have either a bachelor’s or a master’s degree in social work. Depending on the state, they may also be required to have a social work license.

Do I Need a Case Manager?

People coping with complex situations — either  their own or of someone close to them — such as physical illness, disabilities of any sort, the aging process, emotional or psychological challenges, family problems, addictive behavior, problems with school or work — may benefit from case management services.

Seeking help is a sign of strength and may benefit both you and your loved ones.

Who Pays for Case Management Services?

It depends on your situation. Commercial health insurance, Medicare, Medicaid, or Tricare may pay for case management services delivered within some settings, such as hospitals, rehabilitation, or long-term care settings. In nonprofit or government agencies, case management services may be available on a sliding scale basis or even offered free of charge to eligible consumers.

On the other hand, geriatric care management is generally not covered by public insurance or commercial health insurance. Some long-term care insurance policies may cover geriatric care management, and some nonprofits or public agencies may offer it on a sliding-scale basis; otherwise, it tends to be a private-pay service.

How Can I Find a Case Manager?

Again, this depends on your situation. If you are hospitalized or dealing with a system such as workers’ compensation, you may be linked automatically with a case manager. Don’t hesitate to ask if you are unsure. Otherwise, your health care provider, school, employee assistance program, or community service agency may be able to refer you.

Local departments of aging and disabilities, health, and social services frequently offer case management services or may be able to refer you to case management agencies or professionals. You may also want to check with one of the professional organizations representing case managers.

Licensed social workers who provide case management services are listed at Find a Social Worker. Search by specialty area, such as aging; then click on an individual provider from the listing and look for case management under theoretical approach.

Regardless of whether you personally select a case manager or are paired with one you did not choose, it is essential that you feel comfortable with her or his approach. Don’t be afraid to assert your needs, perceptions, and goals. Case management should always involve, and directly benefit, you or your loved ones.

What does “Transitions of Care” mean?

This is an important topic receiving increased attention in the media. A transition of care takes place when people move between care settings (such as when a person leaves the hospital and returns home or goes to a rehabilitation facility), or care providers, such as physicians and other members of the care team, or agencies involved with the same client or family.

Care transitions also occur when a person’s condition or situation changes. For example, a person with a serious physical or mental illness may have a relapse, or a child may leave a foster home and return to her or his family. Lack of coordination during  care transitions is, unfortunately, quite frequent and can be disastrous for everyone involved. Failure to transfer important information and medication errors are two examples of common problems that occur during care transitions.

Case managers, and social workers in general, are integral to successful transitions of care. They help to facilitate communication among everyone involved, including you and your loved ones.

Recognizing the importance of care transitions, NASW has been actively involved in efforts to ensure better care transitions for people receiving health and behavioral health care. As a member of the National Transitions of Care Coalition (NTOCC), NASW is developing resources to educate other professionals, the public, and policymakers about this crucial issue.

For more information, visit National Transitions of Care Coalition.

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