Another Look at Roles and Functions: Has Hospital Case Management Lost Its Way?

Professional Case Management
Vol. 18, No. 5, 246-254

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
CE
Another Look at Roles and Functions

Has Hospital Case Management Lost Its Way?
John J. Reynolds, BA, LCSW
ABSTRACT
Purpose of the Study: The purpose of this study was to identify the roles, functions, and types of activities that
hospital case managers engage in on a day-to-day basis and that leverage the most amounts of time. Previous
studies superimpose a priori categories on research tools.
Practice Setting: Hospital case management.
Methodology and Sample: This study analyzes 4,064 spontaneous, unstructured list serve postings from the
American Case Management Association Learning Link list serve from August 15, 2011, to August 18, 2012. The
study group was a cross section of 415 case management professionals.
Implications for Practice: The data suggest that hospital case managers time is inordinately leveraged by
issues related to observation status/leveling of patients and the Centers for Medicare and Medicaid Services
compliance. The data also suggest that hospital case management has taken a conceptual trajectory that has
deviated significantly from what was initially conceived (quality, advocacy, and care coordination) and what is
publicly purported. Case management education and practical orientation will need to be commensurate with
this emerging emphasis. Case management leadership will need to be adept at mitigating the stresses of role
confusion, role conflict, and role ambiguity.
Key words: compliance, functions, role conflict, roles
here have been numerous studies attempting to

define case management roles, responsibilities,
and essential functions (Tahan & Campagna,
2010). Given the diversity of settings, case management models, and organizational idiosyncrasies, most
studies tend to produce vague, overgeneralized findings and one-size-fits-all assertions. Responses to
survey questions often reflect research bias, given the
tendency to provide socially desirable responses.
The American Nurses Credentialing Center (ANCC)
conducted an extensive Nursing Case Management
Role Delineation Study, identifying 66 work activities
ranked hierarchically by overall criticality (ANCC,
2011, p. 6). The ANCC (2011) states, Role delineation or job analysis studies are typically carried
out at the national level with the goal of describing
current practice expectations, performance requirements, and environments. ANCC has a current goal
of conducting a study of each specialty approximately every three years in order to capture changes
in work activities and the knowledge and skill areas
required to perform those activities. The findings are
used to update the content of its respective certification examination (p. 5). But do role and function
studies actually capture the day-to-day involvement,
interests, and struggles of hospital case managers?
Hospital case managers have been described as
professionals in the hospital setting who ensure that
246
patients are admitted and transitioned to the appropriate level of care, have an effective plan of care and are
receiving prescribed treatment, and have an advocate
for services and plans needed during and after their
stay (Wikipedia, n.d., para. 3). Key roles associated
with hospital case management include variance analysis, care coordination, optimal patient and hospital outcomes, quality of care, efficient resource utilization, and
reimbursement for services (Wikipedia, n.d., para. 3).
Phaneuf (2008) provides an extensive overview of the
nursing case management role. However, the overview
fails to capture the present inordinate emphasis on Centers for Medicare and Medicaid Services (CMS) compliance and utilization review. One study reports, Almost
two thirds of case managers say that patient satisfaction
is the number one factor they consider when evaluating a case managers performance (Health Law and
Regulation, 2010, para. 3). Others stress, Case managers freed from the need to perform routine chart reviews
can work with physicians to manage progression of
Address correspondence to John J. Reynolds, BA, LCSW,
Care Management & Patient Access, Saint Vincents
Medical Center, 47 Long Lots Rd., Westport, CT 06880
(jrccm@optonline.net)
The author reports no conflicts of interest.
DOI: 10.1097/NCM.0b013e31829c8aa8
Professional Case Management Vol. 18/No. 5
Copyright 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
NCM200342.indd 246
7/30/13 7:24 PM
care from hospital to community (Daniels & Frater,

2011, para. 3). In The Gestalt of Case Management,
Powell (2012) notes the following job titles encompassing case management: care coordinator; case manager;
care manager; clinical resource coordinator; guided
care nurse; health coach; medical home care coordinator; patient navigator; patient motivator; resource coordinator; resource manager; transition coach; utilization
manager; and discharge planner.
The Case Management Society of America (2010)
promulgates the following standard for case management: Case management is a collaborative process of
assessment, planning, facilitation, care coordination,
evaluation, and advocacy for options and services to
meet an individuals and familys comprehensive health
needs through communication and available resources
to promote quality cost effective outcomes (p. 8).
The Case Management Society of America 2010
standards (p. 7) assert that their standards reflect
many changes in the industry, which resonate with
current practice today. Some of these changes include
the following:
Minimizing fraxgmentation in the health care
system
Incorporating adherence guidelines and other
standardized practice tools
Using evidence-based guidelines in practice
Expanding the interdisciplinary team in planning
care for individuals
Navigating transitions of care
Improving patient safety
The underlying premise of case management is
based in the fact that, when an individual reaches
the optimum level of wellness and functional
capability, everyone benefits: the individuals being
served, their support systems, the health care
delivery systems, and the various reimbursement
sources. Case management serves as a means
for achieving client wellness and autonomy
through advocacy, communication, education,
identification of service resources, and service
facilitation. Case management services are
best offered in a climate that allows direct
communication between the case manager, the
client, and appropriate service personnel, in order
to optimize the outcome for all concerned. (Case
Management Society of America, 2010, p. 9)
Although laudatory, do these high-level rhetorical statements of standards resonate with actual hospital case management activity?
METHODOLOGY
In an attempt to cast light on the actual day-to-day
roles, tasks, functions, and issues that hospital case
managers are immersed in, the author conducted a

content analysis of 4,064 list serve postings on the
American Case Management Association (ACMA)
Learning Link, from August 18, 2011, to August 18,
2012. ACMAs Learning Link is described as a vast
electronic network that connects members through
an e-mail list serve. Members ask questions and share
their experiences, tools, resources, successes, and perspectives. When you have a question or challenge,
over 2,500 case management professionals are only an
e-mail away. Learning Link is provided as a Member benefit of the American Case Management Association (ACMA website, n.d.; Learning Link: Whos
in Your Network? para. 2 and 3). Also, it should be
noted, ACMA accepts no responsibility for the opinions and information posted on this site by others.
ACMA disclaims all warranties with regard to information posted on this site, whether posted by ACMA
or any third party (ACMA website, n.d., Learning
Link Disclaimer & Legal Rules, para. 1).
Postings were placed by 415 hospital case managers and physicians. Postings were categorized by
subject heading and assessment of content for salient
themes. Subject categories are not mutually exclusive,
because postings might cross-reference other categories. As with all studies, data interpretation rests on
certain assumptions. These data assume that the case
managers postings on the ACMA Learning Link are
a representative sample of hospital case management
professionals and medical consultants. Therefore,
the findings are subject to multiple interpretations.
Figures 1 to 3 are accompanied by a glossary that
operationally defines the figure categories.
FINDINGS
The data illustrate that the issues related to the CMS
compliance, 719 posts (18%), and specifically observation status and the accurate leveling of patients, and
935 posts (23%), have emerged as an intractable leverage of time for hospital case managers (Figure 1). It is
surprising that observation status was identified as a
problem area in 1994, with the Health Care Financing
Administration publishing rules for appropriate utilization of observation status in 1996, followed by the
inclusion of observation status in the Office of Inspector
General Work Plan in 1998 (HCPro Inc, 2008). Utilization review committees have been authorized to change
patients status from inpatient to outpatient since 2004
(Center for Medicare Advocacy, n.d.). Nonetheless,
despite more than 18 years of grappling with the issue,
hospital case managers seem shackled to observation
status and the appropriate leveling of patients.
Discharge planning/care transitions ranks a distant third with 579 posts (14%), and best practice/
quality only (6%), metrics/outcomes 77 posts (2%).
Vol. 18/No. 5
Professional Case Management 247
NCM200342.indd 247
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a
935
719
579
74
30
A
M
19
TE
76
77
106
D
O
116
R
EA
D
M
U
TC
O
M
ES
PH
YA
D
V
M
PL
122
156
ED
163
JD
179
D
C
P/
C
O
ST
202
B
S/
A
D
M
236
I
TR
A
N
S
B
ES
TP
R
A
C
ST
FF
N
G
C
R
IT
ER
IA
D
EN
IA
LS
B
IL
LN
G
SO
FT
W
A
R
E
259
A
TU
S
Posts
1000
900
800
700
600
500
400
300
200
100
0
PHYSADV
OP
2%
TEAM
1%
METRICS
0%
READM2%
DOC
MISC
3% ED
2%
0% OBS/ADM STATUS
JD
3%
23%
3%
SOFTWARE
4%
BILLNG
COMPLI
4%
18%
DENIALS
4%
CRITERIA
5%
DCP/TRANS
STFFNG
14%
6% BESTPRAC
6%
OBS/ADM STATUS
COMPLI
DCP/TRANS
BESTPRAC
STFFNG
CRITERIA
DENIALS
BILLNG
SOFTWARE
JD
ED
READM
METRICS
PHYSADV
DOC
OP
TEAM
MISC
FIGURE 1
Hospital case management role and function as reflected by American Case Management Association Learning Link
posts from August 15, 2011, to August 18, 2012 (n = 4,064). ADM = admission; DCP = discharge planning; DOC =
documentation; ED = emergency department; JD = job description; OBS = observation; OP = outpatient.
Figure 2 integrates the combined impact of CMS compliance issues and distinct compliance and revenue
integrity issues related to observation status accounting for 1,654 (41%) of all postings. If we were to
consider the revenue implications of compliance and
observation and combine those categories with Billing, Utilization Review Criteria, Physician Advisor,
and Denials, Figure 3 illustrates a combined impact of
2,348 (58%). This is significant, because case managers often find that organizational business imperatives
often conflict with other facets of their professional
identity, such as patient advocate. Of note is that
Team Building received less than 1% of the overall
postings. This may suggest that Team Building has
been satisfactorily addressed by organizations or that
other activities preclude team building activities.
DISCUSSION
The frequency distribution among categories suggests
that hospital case management is strategically positioned to impact revenue and manage risk. However,
has it done so at the opportunity cost of commitment
to quality and patient advocacy? Cohen (2012) notes,
248
Utilization review has a primary goal that is administrative in nature, that is, to place patients in the proper
status and fulfill our obligation to provide assistance as
to the optimal utilization of resources and patient care.
It is stated at the outset that these issues are marked
by potential conflict between patient care and placing barriers to that care (p. 263). Daniels and Reece
(2007) state, Because their work was heavily centered
on utilization review tasks, nurses became the chart
police and the instruments for growing chart review
activities, such as core measure abstracting, medical documentation review, concurrent coding assignments, safety indicators, and numerous other performance improvement projects. The idea of resource
appropriateness, advocacy, and navigation through the
episode of care, cost reductions, and improved quality vanished, except for an obligatory mention in the
job description (para. 3). The 4,064 ACMA Learning Link postings call into question the initial vision
of case management. With the big picture perspective, the hospital case manager harnesses the collective
wisdom of the clinical team to assess, plan, and continuously evaluate the patients post-acute experience
(Phoenix Medical Management, n.d., para. 6).
NCM200342.indd 248
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FIGURE 2
American Case Management Association Learning Link posts. DCP = discharge planning; ED = emergency
department; OP, outpatient.
1654
831
694
492
358
STFFNG
9%
BESTPRACT
12%
TEAM
0.5%
MISC
0.4%
16
M
IS
C
TE
A
M
S
TF
FN
G
B
ES
TP
R
A
C
D
EN
IA
LS
TR
A
NS
19
C
AR
E
1800
1600
1400
1200
1000
800
600
400
200
0
C
O
M
P
LI
A
N
C
E
COMPLIANCE
CARE TRANS
COMPLIANCE
41%
DENIALS
BESTPRACT
STFFNG
DENIALS
17%
TEAM
MISC
CARE TRANS
20%
FIGURE 3
American Case Management Association Learning Link posts by major category and percent.
Vol. 18/No. 5
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In an effort to justify and prove our organizational worth, perhaps case management
leaders inadvertently contribute to the myriad confluence of varied roles and
expectations that are assumed and consequently required of staff. Or, maybe as
helping professionals, we are all too willing to have our capacity to care exploited as
we compensate for organizational and leadership voids.
Does the dominance of CMS compliance, patient
assignment, and/ or leveling signify a risk that would
fragment the unified skill set of case management
into individual elements creating the biggest threats
to case management to building recognition of, and
consistency in, the professional practice of case management? (Powell, 2012, p. 228). I believe that the
implications of the issue are exquisitely expressed in
Smiths (2011) treatment of role ambiguity, role confusion, and role conflict in hospital case managers.
Although less overt than in the past and ample
rhetoric to the contrary, many health care organizations
continue to harbor a culture of blame. Because hospital operating margins continue to shrink, determining
patient status and the concomitant compliance and
operational implications have engendered increasing
amounts of audit anxiety and undermine team cohesion. I have seen the abdication of other disciplines relative to Observation and patient leveling create a void
that case managers have been compelled to fill. From
the framework of thermodynamic theory, entropy is
a measure of a systems energy that is unavailable for
work or of the degree of a systems disorder or trend
toward disorder (Entropy, n.d.). I would argue that the
inordinate reliance on Case Management Assignment
Protocols and other first-level review screening methodologies signify hospital case managers confronting a
state of organizational and physician entropy. Because
there is not a sufficient energy contribution by other
sources, hospital case managers compensate for a multitude of organizational systemic deficits on the road
to professional burnout.
In my own experience, with rare exception, the
physician community has taken the stance that the
leveling of patients is an administrative, nonclinical
issue. Medical coders who have their own credentialing and practice guidelines consistently ask case
managers how they should code on the basis of what
the physician has (or has not) documented. Organizational goal misalignment manifests as Emergency
Departments move patients out at a rate of acceleration that precludes hospitalists accurately leveling
a patient at the point of entry. Emergency department
registration processes frequently do not cohere to clinical/regulatory requirements by using the colloquial
of Admit and Observation and create a web of
confusion. Emergency department physicians, with
250
no admitting privileges, write transitional orders that

are confused with admission orders. The confluence
of these forces creates massive amounts of re-work
that case managers are held accountable to unravel at
the back end. Compliance officers, Departments of
Revenue Integrity, too often take a step back, deferring to case managers who then assume responsibility and liability for any missteps in what is the convergence of several volatile issues, leaving hospital case
managers as the repositories for risk assumption.
A review of legal and regulatory issues seems
to focus exclusively on Protected Health Information (Muller, 2012, 2013). This is consistent with the
2010 ANCC Role Delineation Study Overview survey findings, which ranked, maintains clients confidentiality as the number one work area relative to
overall criticality for hospital case managers (ANCC,
2011, p. D2). However, the slippery slope of case
managements entry into billing compliance, admission status determination, revenue integrity, and
interpretation of CMSese as it explains, or tries
to, CMS regulatory stipulations for billing and take
backs have received little attention as a professional
practice issue. In fact, the ANCC survey question,
Reviews level of care based on utilization review criteria, did not rank in the surveys top-20 work items
relative to overall criticality (ANCC, 2011, pp. 12).
There has been a consistent failure to capture this
shift as a professional practice issue and to offer guidance as how to navigate the changing landscape. Perhaps the 2011 American Case Management Association National Hospital Survey (pp. 3233; this survey
is available to ACMA members only) is instructive,
while noting a statistically significant increase in the
number of case management departments reporting
to operations and other departments, whereas
the number of departments reporting to nursing/
patient care services is almost equal to the number
reporting to finance. This finding is again reflected in
the 2013 ACMA National Hospital Case Management Survey (p. 23). Role confusion, role ambiguity,
role conflict, and role tension have emerged as central
themes in defining case management integrity as a
practice specialty. There is evidence to suggest that, in
varying degrees, these practice strains have not only
job satisfaction and job effectiveness implications
but mental health ramifications relative to burnout
NCM200342.indd 250
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containment and financial issues; some perceived this

expectation as conflicting with their role as patient
advocate and created tension as well as decreased
job satisfaction and self-confidence. Also was noted
the participants perception of not being aware of the
aspects of the case management role and of not being
prepared for the role and not aware of the aspects of
case management that would be problematic (Smith,
2011, p. 184). Gray, White, and Brooks-Buck (2013)
astutely note, it is clear that role conflict and role
ambiguity are important intervening variables that
mediate the effects of various organizational practices
on individual and organizational outcomes (p. 69).
The authors also found that many responses indicate
that there is role confusion and conflict and ambiguity related to the areas of time, resources, capabilities,
and the multiplicity of roles and responsibilities.
Nurse case managers are held to different sets of standards that could be at odds with each other (p. 72).
It is true that case managers are a unique segment
of the healthcare workforce, therefore, their unique
role needs to be clearly articulated if the specialty is
to gain industry-wide recognition and standardization (Gray et al., 2013, p. 72). However, there is
a good reason to believe that case management has
become the Swiss Army Knife of health care, engaged
in quality, utilization management, denial management, family intervention, discharge planning,
compliance, etc. (see Figure 4). Although a seeming
organizational convenience, the Swiss Army Knife
The frequency distribution among

categories suggests that hospital case
management is strategically positioned
to impact revenue and manage
risk. However, has it done so at the
opportunity cost of commitment to
quality and patient advocacy?
as hospital case managers endeavor to reconcile the

many roles and expectations in a manner that is professionally acceptable.
In an effort to justify and prove our organizational worth, perhaps case management leaders
inadvertently contribute to the myriad confluence of
varied roles and expectations that are assumed and
consequently required of staff. Or, maybe as helping
professionals, we are all too willing to have our capacity to care exploited as we compensate for organizational and leadership voids. Smith (2011) has written
insightfully about role ambiguity and role confusion for nurses transitioning from bedside to nursing
case management. Specifically, within the business
culture and financial objectives theme, participants
revealed feelings of conflict and being at odds with
the employer regarding the expected focus on cost
Observation/inpatient only
Discharge
planning
Utilization
management
Quality
improvement
RAC take backs

Risk
management
Core
measures
Tracking
variances
Pt./Family
advocacy
Team
leader
Outcomes
monitoring
Billing
Care progression
HIM consultant
Regulatory
compliance
John J. Reynolds
FIGURE 4
Hospital case management and role confusion case management as the Swiss Army Knife of health care. HIM =
health information management; RAC = recovery audit contractors.
Vol. 18/No. 5
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as an All in One solution is not a sustainable tool

(Fry, 2007; Reynolds, 2004). It is meant as a stop-gap
measure, not as a long-term solution because each
application is a substitute for a full size, enduring,
more efficacious specialty instrument.
Many organizations fail to recognize that hospital case managers provide direct care to patients.
Although not necessarily at the bedside, they are
direct care workers. The integration of case and
manager as a job title creates a distortion of what
case managers do. First, case manager implies an
inordinate and misleading amount of control in the
face of a multiplicity of organizational and external
forces. Second, manager implies a nondirect care
function with inherent hierarchical authority. I have
been astounded at the amount of committee time
direct care/case management staff spend in meetings,
thus vitiating their direct patient service activities and
creating time constraints relative to their numerous
other activities.
and update where needed. Revise departmental

orientation as indicated.
Use relevant articles and case vignettes at staff
meetings to support staff and foster the coordination and integration of specialties.
Utilize guest speakers who are subject-matter
experts to support training and departmental
curriculum development.
Develop presentations for professional workshops and conferences that address the changing
landscape and related skill sets while focusing on
maintaining a commitment to core values.
The multitude of titles, functions, and activities
that hospital case managers find themselves engaged
in is testament to case managements organizational
value. It is no wonder that hospital case managers
report role strain, role ambiguity, role conflict, and
feelings of burnout. Nonetheless, hospital case management cannot be allowed to become a victim of its
own aspirations and its own success.
What Can Be Done?

Case management practice education and departmental leadership will need to address the actual day-today operational and clinical emphasis on CMS compliance and the interface of professional practice and
organizational business imperatives and the impact
on the integrity of hospital case manages role boundaries, role conflict, and role ambiguities.
Case management is what I call a lynchpin
practice specialty with numerous spokes emanating out to other departments. Heeding Powells caution that case management functions need not become
independent titles, I do believe that there does need to
be some acknowledgment of both the specialty skill
and its link to the core case management role. A compromise nomenclature might be as follows:
Case management utilization specialist.
Case management compliance/recovery audit contractors specialist.
Case management quality specialist.
Case management discharge planning/care transition specialist.
If job descriptions cannot be specialized, stipulate to new recruits what percentage of time is
expected in each function/activity.
Create clear reporting relationships with other
departments.
Orientation: Guarantee that each function
receives the requisite amount and type of training/
preceptorship to engender confidence and competence.
Use staff meetings to explore whether current job
descriptions reflect current departmental practice
252
Operational Definitions
Best practice/quality: Standards of care for specific disease states, professional articles, certification, The Joint Commission compliance.
Billing: Non-RAC, billing-related issues.
Compliance: CMS-related guidance and regulatory adherence.
Observation: Admission status orders, RAC, prepayment reviews, utilization management plans.
Care Transition: Difficult discharges, discharge
assistance programs, discharge resources, transfer centers; readmissions; emergency department;
outpatient.
Denials: Non-CMS utilization review activity,
denial management, criteria
Documentation: Issues related to clinical documentation improvement and other charting
issues.
Emergency department: Issues related to emergency department functioning, including staffing,
coverage, job descriptions.
Outcomes: Issues related to benchmarking, targets, acuity systems.
Job descriptions (nonemergency department): Issues
related to various job descriptions, including case
management, utilization review, transfer center.
Outpatient: Issues related to outpatient procedures, billing, and outpatient staff roles.
Physician advisor/physician roles: Issues related
to physician advisor, attending physician, medical
director roles.
Readmissions: Issues related to readmission prevention, tracking.
NCM200342.indd 252
7/30/13 7:24 PM
Staffing: Issues related to roles/responsibilities,

departmental structure, policies, staff ratios,
mission.
Software/IT: Issues related to discharge planning,
case management/utilization review software, electronic medical records, meaningful use, etc.
Team building: Issues related to interdisciplinary
team building and huddles.
Misc.: All other issues (see Figure 1).
Compliance: CMS-related guidance and regulatory
adherence.
Observation: admission status orders, RAC, prepayment reviews, utilization management plans.
Discharge planning/care transitions: Difficult
discharges, discharge assistance programs, discharge resources, transfer centers.
denial management, criteria.
Physician Advisor/Physician Roles: Issues related
to physician advisor, attending physician, medical director roles.
Documentation: Issues related to clinical documentation improvement and other charting issues;
Billing: Non-RAC, billing-related issues.
Outcomes: Metrics: Issues related to benchmarking,
targets, acuity systems; Information technology/
software: Issues related to discharge planning,
case management/utilization review software,
electronic medical records, meaningful use, etc.
departmental structure, policies, staff ratios,
mission.
Job descriptions (nonemergency department):
Issues related to various job descriptions, including case management, utilization review, transfer
center.
Outcomes: Issues related to benchmarking, targets, acuity systems; Information technology/
software: Issues related to discharge planning,
case management/utilization review software,

electronic medical records, meaningful use, etc.
Compliance: CMS-related guidance and regulatory adherence.
Observation: Admission status orders, RAC, prepayment reviews, utilization management plans.
Discharge planning/care transitions: Difficult discharges, discharge assistance programs, discharge
resources, transfer centers.
denial management, criteria.
Physician advisor/physician roles: Issues related
to physician advisor, attending physician, medical director roles.
Documentation: Issues related to clinical documentation improvement and other charting
issues; Billing: Non-RAC, billing-related issues.
departmental structure, policies, staff ratios, mission.
Job descriptions (nonemergency department):
Issues related to various job descriptions, including case management, utilization review, transfer
center.
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John Jude Reynolds, CCM, CPHM, LCSW, has been a CCM since
1996 and a health care manager for 24 years. He has published numerous articles for the American Hospital Association and most recently in
the American Journal of Nursing. John is currently the Director of Care
Management & Patient Access at St. Vincents Medical Center, Westport
Campus, Westport, CT.
For more than 38 additional continuing education articles related to

Case Management topics, go to NursingCenter.com/CE.
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Another Look at Roles and Functions: Has Hospital Case Management Lost Its Way?

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Professional Case Management

Vol. 18, No. 5, 246-254

Another Look at Roles and Functions

here have been numerous studies attempting to

Professional Case Management Vol. 18/No. 5

care from hospital to community (Daniels & Frater,

managers are immersed in, the author conducted a

Professional Case Management 247

Professional Case Management Vol. 18/No. 5

Professional Case Management 249

no admitting privileges, write transitional orders that

Professional Case Management Vol. 18/No. 5

containment and financial issues; some perceived this

The frequency distribution among

as hospital case managers endeavor to reconcile the

RAC take backs

Professional Case Management 251

as an All in One solution is not a sustainable tool

and update where needed. Revise departmental

What Can Be Done?

Professional Case Management Vol. 18/No. 5

Staffing: Issues related to roles/responsibilities,

case management/utilization review software,

Professional Case Management 253

Muller, L. S. (2013). Editors commentary. Professional

For more than 38 additional continuing education articles related to

Professional Case Management Vol. 18/No. 5

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