What is the primary function of case management in healthcare?

The primary function of case management in healthcare is to perform utilization review and manage patient care. This role involves coordinating various aspects of patient care, ensuring that patients receive the appropriate services while also adhering to standards of care and efficiency. Case managers assess patients' needs, identify resources, and develop care plans that facilitate effective treatment and support.

Utilization review is an essential component of this function, as it involves evaluating the necessity, appropriateness, and efficiency of the healthcare services provided to patients. This ensures that healthcare providers are making the best use of resources and that patients are receiving care that is both medically necessary and cost-effective.

In contrast, activities such as patient billing, ensuring compliance with medication protocols, and scheduling patient appointments, while important in the healthcare process, do not encapsulate the primary focus of case management, which is centered around overseeing and coordinating comprehensive patient care. This patient-centered approach is crucial for improving health outcomes and optimizing the overall operation of healthcare facilities.