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Most people think that case management is limited to health, social work, or the law. Medical professionals use it to plan and monitor healthcare services. Whereas, in legal management, people use it for legal purposes and to keep track of legal cases.

Though case management started within these industries but today, it has been adopted by almost all kinds of businesses. It has become essential for organizations looking to bring order to their workflow.

The Global Case Management Software Market is expected to grow from USD 3,802.20 Million in 2019 to USD 7,587.54 Million by the end of 2025 at a Compound Annual Growth Rate (CAGR) of 12.20%

In this article, we will discuss case management and how organizations can use it to enhance efficiency.


What is case management?

Case management refers to the work done during the processing of data and procedures relevant to the case. A case can be a service request to be fulfilled, an investigation to be conducted, or an issue that needs to be resolved.

Case management is not an entity but a practice of assessing, planning, implementing, monitoring, and evaluating the services that may be required, for example, to meet an individual’s health needs.

Being started as an important practice in the healthcare department, case management has outgrown itself, and it is playing an essential part in different industries and organizations.

Philosophy of Case Management

As mentioned above, case management is the practice of facilitating the client’s needs and requirements by advocating assessment, planning, communication, and education. Based on the client’s requirements, the case manager links the client with appropriate service providers while ensuring the care provided to the client.

The client refers to the person receiving the case management services, for example, in the health department, the patient. However, it may not be limited to customers, clients, or patients only.

What Is a Case Manager?

A case manager is a person who assesses the client’s needs and requirements and links them to the available resources and services. He acts as the single point of contact between the case and the client. A case manager is not a service provider but a service facilitator.

In the case of healthcare or social work, a case manager is usually the nurse or the social worker trained to meet the patient’s treatment needs, create, evaluate and execute the plans and facilitate them.


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Types of Case Management Models

Initially, the case management models were designed for non-profit organizations. However, if any of them fits your case requirements, you can implement them in your case management system.

You can customize or edit them to suit your case requirements. They can be used in a variety of case management settings for different individuals. The three main case management models are listed below.

The Clinical Case Management Model

This model was designed for case managers to provide therapeutic services to clients. The case manager creates a plan to utilize services from mental health to physical therapy. The case manager makes sure that the client is utilizing all therapies, and they also meet them regularly to discuss ongoing care.

The Brokerage Case Management Model

This approach is relatively hands-off as compared to other models because it consists of less client-manager interaction. It focuses on evaluating the needs and services of the client and providing ongoing treatment.

The Strengths-Based Clinical Case Management Model

As the name suggests, this model is based on the client's strengths. The role of the manager is to analyze and identify the personal strengths (including community, family, and friends) of the client, and resolve the case according to the requirements.

Adaptive Case Management vs. Dynamic Case Management

You will often see these two terms used interchangeably in the case management process. They are very similar to one another, and for the most part,  they mean exactly the same. They both describe a case management system that makes the user in charge but also lets the system work with the user to identify the appropriate workflow.

Adaptive Case Management works and examines the previously handled cases by a user and gathers information, and makes decisions based on the information.

Whereas, Dynamic Case Management takes advantage of the ongoing case management process and the event occurring in the middle of the workflow. This helps in recommending and making changes in how the case is handled.


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How does Case Management Work?

Case management works on different interfaces and brings them together using management tools. This single user-friendly interface helps act on workflows and tasks. There are several different tools available for businesses to help them practice case management. These tools help businesses manage unpredictable data-centric work.

The case management process provides a wider view of the information and tasks that can be done to resolve the case.

Moreover, it enhances productivity and enables employees to work and manage cases more efficiently.  They can use dashboards to show reports and work history. Also, these dashboards help them collaborate which can lead to faster resolution of issues.

A case management process consists of a series of steps to turn a complex issue into a manageable workflow and resolve the case.

A high-level case management process looks like this:

  1. Screening
  2. Assessing
  3. Evaluating Risks
  4. Planning
  5. Implementing
  6. Following-up
  7. Evaluating outcomes

Case managers follow these steps while keeping into consideration the client’s beliefs and case requirements.

Screening

The first step of the case management workflow is the screening of the case. This step is done to identify the basics of the case. Another reason to execute this step is to identify whether the case needs case management or not.

For example, an employee made a complaint, and in the screening process, you have to determine whether the complaint is real or not. If in the screening process, the complaint turned out to be a misunderstanding then there is no need to run the whole process.

Also, Case management is done for complex cases. Small cases don’t require the time and effort to run case management processes. There is no need to execute a case management process if the case can be resolved in less time.

Assessing

In this step, the case manager gathers information about the client’s case in detail. This step is different from screening because screening is done to determine whether case management flow is necessary or not.

Whereas assessing is for clearly understanding and identifying the problem to provide better solutions.

In this step, the case manager has three primary goals to meet:

  1. To identify the client’s problems to be addressed, their needs, and interest
  2. To determine goals and expected & targeted outcomes
  3. Making a comprehensive case management plan to fulfil these requirements

Evaluating Risks

Once the case manager has assessed a case, it’s time to evaluate the case’s risks. The case manager can assign the case to a risk category in some situations. This enables the case manager to check the severity of a case and how many levels of intervention are required.

In this way, the case manager will be able to see the urgency of each case and prioritize them accordingly. This, in turn, will help the case manager make a specific plan to resolve the case.

Planning

The purpose of the planning phase is to establish care goals, objectives, and actions required to meet the client’s needs. The case manager will make a case management plan to answer the problems discovered during the assessment phase.

In the case management plan, the case manager must identify measurable outcomes and make them achievable within a specific time period.

Implementing

In the implementation phase, the case manager executes the actions and interventions outlined in the client's case management plan of care.

During the execution of the case management plan, the case manager must pay close attention to the methods and find out whether their methods are effective or not.

Following-up

The goal of this step is to review, evaluate, monitor, and reassess the client’s case and the outcomes of the implemented interventions.

The case manager will analyze the problem to see how effective the implementation was. Let’s say the case manager calls the client to collect information and checks if the problem still exists.

The case manager will also determine if the plan needs to be adjusted or changed. If so, the case manager will again make a case management plan. After that, he will do additional follow-ups to check if the new plan implemented worked or not.

Evaluating outcomes

Once the plan is implemented successfully, it’s time to evaluate the outcomes of the case management process. The case manager will collect feedback and note down the documentation, results, quality, and duration of the case management process.

Another purpose of this step is to generate a report to analyze the return on investment and the cost-profit of the process. After this, the findings are distributed among key stakeholders, which in turn improves the process.

It can also help in future cases. If a case similar to one of the previous cases comes up, the case manager can implement methods that worked and avoid strategies that didn’t work in the past.

Common Elements in a Case Management Process

A case management framework consists of the information the case manager needs to carry on the project. Since every business is unique, the workflow and the process depend on the business requirements.

In this regard, case management processes are made highly customizable and flexible so that they can be adjusted according to the needs of any industry or business.

Although the process is flexible, the dynamic and adaptive structure follows a series of key features in a case management workflow. Among them are:

Gather Information and Customization of Process

It is necessary to gather information before starting any complex process. In this regard, information is collected and customized according to the business requirements.

Collaboration on a Customized Interface

Once the information is assessed, it is stored in a single database or file storage so that other users can collaborate in the process on a user-friendly interface to check issues and process information.

Decision Making

After processing the information, decisions are made based on the case requirements. The case managers find out the best course of action through automated rules or critical thinking.

Keep Records

Every action taken in the case management process is recorded for audit and record-keeping purposes. This makes it easier to understand the effective methods to resolve the case and keep case history.


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Example of Case Management Use Cases

The case management framework is suited for many different work patterns. They can be used for both business cases and system cases. In both situations, they are proven effective.

Here are some common use cases of case management.

Service Requests

Customers or employees make service requests to work on or repair any asset. These requests can bring many challenges to organizations. Successful management of service requests requires automated workflow and case management processes in organizations.

Claims Processing

Claims Processing is an essential need of organizations. The process starts when an employee or customer files a claim. This may be challenging for organizations due to the potential for fraudulent claims.

Using case management, organizations can automate the claim processing workflow.

Employee onboarding

Employee onboarding is also one challenging task for HRs. If organizations don’t take these situations seriously, it affects employee engagement and productivity.

Here, case management plays an essential role in successful and automated employee onboarding.

Error messages & bug tracking

Almost every organization faces errors and bugs in their system functions once in a while. To continue the workflow, these errors and bugs must be reported, investigated, and resolved.

Using case management, organizations can log and validate errors, create plans to resolve them, and gather useful feedback.

Requests & approvals

Case management processes help in streamlining requests and approvals to keep every stakeholder informed. They can then get access to information and communicate on the issues.

What Is Case Management in Nursing?

Case management in nursing is when the nurse follows up on a patient's health needs and requirements. In nursing case management, the nurse acts as the case manager, and they participate with the patients to identify options and facilitate services according to their health conditions.

Also, the nurse care managers make sure that the patient receives the care and rehabilitation necessary for their recovery.

What Is Case Management Software?

Case Management Software is a digital tool or system organizations use to track and keep records of clients’ data. These records may include the client’s information, case notes, client communication, billing, and case history.

Case management processes revolve around a lot of information collection. Case managers have to work with dozens of clients and collect their information. It’s hard to keep a record of a lot of information without reliable software.

Case management software provides one place for case managers to store information, visualize it, create reports, and leverage the data they collect.


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What Is Targeted Case Management?

Targeted Case Management (TCM) is a set of direct services and facilities provided to a Target Population of adults and children who have serious mental health issues or emotional disorders.

TCM provides them access to needed medical, clinical, and education services they may need to live a stable, safe, and healthy life.

Why Should Organizations Use Case Management?

Organizations need case management when they want to be flexible while resolving complex cases. They want the user to have control while having an organized structure of the workflow. So that they can make the best decision to resolve the case.

Case management means happy customers as their requirements are met. Also, satisfied and productive employees because they will get what they want to continue the process.

Apart from these, case management has other benefits too. Some of them are:

  • A better understanding of clients
  • Quick resolution of issues
  • Employee productivity and efficiency
  • Quick access to information
  • Better record-keeping
  • Increased transparency

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What Are The Components Of Successful Case Management?

Intake

collect the information of the new client and create a complete client profile to further process the case.

Needs Assessment

Once the information is gathered, assess the client’s challenges and case risks to have a deeper insight into the case.

Service planning

Service planning is the course of action that needs to be taken to resolve the case. A case manager makes different plans and strategies to meet the client’s objective.

Monitoring and Assessment

With forms and reports, manage the client's success rate. Monitor and assess results continuously to get improved outcomes.

Case Management FAQs

What is the goal of case management?

The goal of case management is to resolve complex cases any business or organization may encounter.

How can case management help my business?

Case management can help your business become more flexible and accountable while resolving cases and issues. It provides a structured workflow to help businesses take control of their business requirements.

Is there any case management software?

Yes, there are many online tools for case management processes.

Is case management software free to use?

No, case management tools are not free. You have to pay some subscription charges to continue using them.

How can case management software help?

Case management software helps businesses by providing them with a platform to store information they collect during the assessment of any case. They help businesses keep a record of every detail they go through during case resolution.


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