A nurse is very interested in learning more about health care economics and how she can use that knowledge to become a better patient advocate
She comments, "Nurses should not only deliver care one day at a time in one facility but should coordinate patient care as they move from acute care to rehabilitation to home care." This nurse would be a candidate for which nursing role?
a. Disease management program (DMP) for chronic illnesses
b. A hospital-based utilization management nurse who reviews medical records to determine the most appropriate DRG for patients
c. Case management
d. Reviewer for Managed Care Organization
ANS: C
Correct: Case management offers nurses the opportunity to demonstrate cost-effectiveness by coordinating patient care at the appropriate level of care across the continuum of care. Patient advocacy and understanding current health care economics are critical to this role.
Incorrect:
a. Disease management programs promote member self-care rather than coordinated care and focus on a defined patient population over the course of a disease.
b. Utilization management nurses review medical records to determine the most appropriate DRG for patients.
d. Nurses who serve as reviewers for Managed Care Organizations consider the patient's medical options and make judgments as to the necessity of the service being considered. Coverage may be denied for unnecessary, excessive, or experimental procedures.
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