Patients in healthcare settings require all caregivers to work cooperatively on their behalf to provide excellent, high-quality care and treatment on a consistent basis. This process is instrumental in shaping a healthcare dynamic which focuses on the needs of patients and which supports the continued growth and development of activities in the practice setting to meet these requirements. However, nurse case managers may face ethical challenges when advocating for their patients when payers may view the circumstances in a different light. It is the responsibility of all case managers to make decisions which are ethically responsible and which provide patients with the best possible care under specific conditions. They play a critical role in this process and must advocate for rather …show more content…
Case managers must adhere to a code of conduct which regulates their behavior and requires them to make decisions which are in the best interests of their patients on a routine basis, and they must “practice only within the boundaries of their role or competence, based on their education, skills, and appropriate professional experience” (Commission for Case Manager Certification, 2015, p. 4). This is of critical importance because it provides a framework for case managers to follow in each decision that is made and to refrain from going beyond the scope of their knowledge and training, even when they believe that they have the knowledge to address a different set of circumstances effectively (Commission for Case Manager Certification, 2015). As a case manager, it is essential that patients who require services are evaluated in a timely manner and that insurance issues are addressed as quickly as possible to prevent health-related complications and other