Accedited case management skills programme

The Institute of Health Risk Managers (IHRM) offers an accredited skills programme for case managers and disease managers working in the Road Accident Fund, Workmen’s Compensation, public and private hospitals, medical schemes and managed care industry.

The accredited skills programme carries credits towards the Wealth Management Level 5 qualification.

Why case management?

Case managers are recognised experts and vital participants in the care coordination team. They empower people to understand and access quality, efficient, cost-effective health care.

Case management is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and utilisation of available resources to promote quality, cost-effective outcomes. The case managers can be the glue of the healthcare system if their services are utilised appropriately, ensuring that the right patient receives the right treatment at the right place, at the right time, by the right provider at the right cost.

Case management can achieve 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 patient, and the healthcare team, in order to optimise the outcome for all concerned.

Why the need for case management training?

Case management seeks to achieve that the right patient gets the right treatment at the right place at the right time and at the right cost, achieving holistic patient centred care. Case managers generally have sound clinical knowledge. However to be a successful case manager one now needs to using the clinical knowledge, top it up with knowledge of the funding environment and the theory of case management ensure that the right principle is applied.

Learner responsibilities

To achieve the credits for this programme, each learner must

  • Attend the six-day facilitation – three modules of two days each
  • Complete assignments
  • Write an exam

Should the learner not successfully complete the assignments or the exam, they will be issued with a certificate of attendance.

Should they successfully complete the entire programme, they will receive an INSETA statement of results, detailing the credits they have achieved against the Wealth Management qualification.

 

The learner will receive forty-one credits on successful completion of this programme.

Course content

The following unit standards will be covered in this module:

 

IDUnit standard titleCredits
242582Analyse the implications of the South African government’s national health policy and the potential impact on medical schemes10
242567Analyse the product design/structure of different medical schemes to evaluate the benefits of each scheme5
242565Manage costs in a specific case with due regard for quality2
242568Apply knowledge and insight of the medical scheme environment to evaluate risk in a selected medical scheme4
242615Demonstrate knowledge and understanding of the financial consequences of a large claim to a client3
242559Analyse and interpret qualitative and quantitative data from relevant reports in order to make a recommendation or inform a decision for an entity5
230078Apply the principles of ethics to a business environment10
242614Adapt and verbally communicate financial information to a range of audiences2

In addition to the unit standards above, the following theory is included in this programme:

  • Principles of health risk management including insurance and health economics
  • Components of health risk management including health risk assessment, health risk management programmes and health risk funding
  • Application of health risk management principles
  • Legislative environment (Medical Schemes Act and its Regulations)
  • Quality management in health risk management
  • Overview of utilisation management
  • Utilisation management monitoring – Coding, benchmarks, guidelines and variances
  • History and definition of case management
  • Standards of case management practice
  • The case management process
  • Level of case management and discharge planning
  • Case manager competencies
  • Leadership and communication skills
  • Motivational interviewing
  • Patient advocacy
  • Ethico-legal considerations

This programme is supported by learning resources, reference material and on-line assessments.

Why choose IHRM as your training provider?

We have facilitated case management training extensively in both the public and private healthcare sectors – hospitals and funders. The facilitators of this programme have extensive knowledge and experience in both the clinical and funding environment. Our experience has shown that there is a need for a better understanding of the potential benefits that case managers can bring to the patie nt, healthcare team and the business if their services are utilised optimally.

IHRM is an independent training provider specialising in providing training for the healthcare industry, and have subject-matter experts to facilitate and support learners in completing the programme.

IHRM is accredited with INSETA to deliver the Medical Claims Assessing, Long Term Risk Assessment and Wealth Management qualifications. This skills programme consists of unit standards from the Wealth Management level 5 qualification. This qualification is used extensively in the medical scheme environment. We have contextualised the unit standards for case managers. Successful candidates will achieve SAQA recognised credits towards this qualification.

For more details contact Irene Zambelis at 011 726 7482 or email on irene@ihrm.co.za