InsightsCase Management

The Top 4 Mistakes That Plague Case Management Teams

02 Feb, 20232:08 PM

Share this article
Streamline Your Medicare Advantage Operations
Get industry insights, best practices & regulatory updates delivered straight to your inbox.
The Top 4 Mistakes That Plague Case Management Teams

The medical fraternity has been using Case Management in one form or the other for a while now. In simple terms, Case Management is a community-based method for managing care for those who are chronically ill. Its underlying philosophy is providing holistic care that encompasses medical assistance, social support for prevention of complications and coordination and facilitation services that help people manage their condition better and stay out of the hospital for longer. With rising workloads and ever-expanding responsibilities, it is pivotal for the Case Management department at any healthcare entity to work out the deficiencies that affect the quality of its work and find solutions for them. 

Here are some mistakes that a Case Management department should watch out for to ensure smooth operations: 

1. Role Blurring

When the responsibilities of the staff are undefined, chances of confusion that could lead to severe errors become very high.  Since most Case Management teams are staffed by highly trained registered nurses and social workers, it is all the more important to avoid under-utilization. As far as possible, each team member should have well-defined duties that do not merge or overlap with others. 

2. Under-Staffing

To avoid poor patient outcomes, it is essential for Case Managers to have manageable caseloads. An appropriate staff size in the Case Management department which takes into account the right blend of social workers and registered nurses will help in reducing discontent which will, in turn, reduce the staff turnover. 

key benefits

3. Missing Administrative Support

Many tasks that can be easily handled by non-licensed support staff are performed by licensed staff since there is either a dearth of clerical support or worse still there is no clerical support at all. Investing in adequate support staff helps offload some of the licensed staff’s burden resulting in improved efficiency and reduced costs. 

4. Lack of coordination

When various teams within the Case Management department work in silos, the outcome is always less than satisfactory for the patient. Every piece of the Case Management machinery needs to work in close synchronization to achieve best results. It is a good idea to promote horizontal as well as vertical communication within the organizational structure of the department to enhance free-flow of information. 

key benefits

The aspects mentioned above are the topmost areas of concern that need constant monitoring and improvement in the field of Case Management. If you have an in-house Case Management department, you should keep these points in mind while working out its long-term strategy. 

Mirra Healthcare is a third-party administrator that offers Case Management services to healthcare facilities of all kinds. It has a well-established team of case managers who can help you handle your patients in a more organized manner. This will not just reduce healthcare costs but also improve patient satisfaction. Reach out to us at- Contact us to request a demo for the services in our Medicare in a box solution.

Back to topBack to top
Simplify Medicare Advantage with Advanced Solutions
Streamline healthcare ecosystem & enhance patient care with Mirra's Medicare Advantage in a Box.
Boost Revenue with Our
Complimentary CMS Reject Analysis
Leverage our in-depth CMS Reject Analysis to improve claim acceptance rates.

Reviews & Testimonials


NANCY GAREAUCEO of Ultimate Health Plans

"In 2021, Ultimate Health Plans (UHP) partnered with Mirra Health Care (Mirra) to develop a software platform to support processing Claims, Customer Service, Eligibility, Enrollment, Premium Billing, Encounter Processing and a Provider Portal for our Medicare Advantage Plans. Mirra collaborated well with our operations and compliance teams to successfully design and implement a system that was innovative, efficient, and compliant with all Medicare and Florida Medicaid guidelines and requirements all within the scope of our required timeline. We greatly benefitted from the Mirra Project Management Team’s regular communication with Stakeholders through monthly meetings and recurring weekly breakout-focused calls, which were geared towards troubleshooting and goal alignment. Mirra was able to quickly maneuver and adapt their systems to our needs, resulting in successful implementation and go-live. Mirra continues to support our compliant operation and growth in the ever-changing healthcare industry rapidly and effectively updating their systems with new Medicare and Florida Medicaid rates and guidelines to ensure seamless compliance and efficiency. I have absolutely no reservation in recommending their systems to any Payer searching for improvement in their operational efficiency."

Recover Revenues with Our CMS Reject Analysis!

Reach out for a no-obligation consult today.

We respect your privacy and do not sell or share your information with third parties. Please read our privacy policy here.