The Basics

This standard requires a systematic oversight of the performance of the case managers through a process known as "case review."  The reviews must be designed to assure that the case managers are helping consumers achieve case management goals through the implementation of case management plans (see CM 19). 

Management Tips

The P&P should describe the case review process, including how often case review occurs, how files are selected, and what should be a part of that case review.  In addition, the P&P should describe who is responsible for case review and how reports should be prepared.  Also, the P&P should address what action -- either at the individual case manager level or the program level -- in response to findings of the case review.  Finally the P&P should specify that aggregate reports of case reviews are periodically submitted to the QM committee.  

URAC Accreditation Tips

Again, start your AccreditNet submission with the P&P described above.  In addition to the P&P, you should submit any templates used in case review, as well as a sample report of the sort submitted to the QM committee.  

The onsite review will involve a review of completed case review reports.  Also, be sure to flag your QM committee minutes at the point in those minutes that the QM committee reviewed the case review reports required by CM 9.   Be prepared, also, for the possibility that the reviewer will select review reports at random from a list of case reviews.  Finally, implementation of this standard is likely to come up during the reviewer's interview of case managers and, in particular, the case management supervisor(s).