What is case management?

A question that a case manager often will be asked is “I thought you were a nurse, what is a case manager?” My explanation most often begins with, a nurse case manager (CM) is one of the most important nursing positions in the hospital for all age groups of patients. They are the glue of the care circle, in and out of the hospital. CMs protect, advocate, coordinate, collaborate from the smallest tasks to life-changing decisions. Bridges in the gaps in healthcare are built, maintained and repositioned to the needs of their patients by case managers. Teamwork within the healthcare community to reach the common goal of a patient’s well-being is often bound together by the CM efforts. 

With the implementation of the Affordable Care Act, access to care has become a challenge, lack of providers in many communities creates long waits for appointments and decreased personalized service. During the pandemic, access was again transitioned to increases in technology-based healthcare, often problematic for the elderly.  While navigating the advancing medical community the elderly often fall through the cracks in healthcare. The elderly population is accustomed to personalized care where they do not have to advocate for their care, they trust without question what is needed will be done. Seniors often get frustrated and give up, angry with the amount of time and energy it takes to get an appointment, fight with an insurance company for a benefit they are entitled to, navigate the pharmaceutical community for affordable medications and a whole list of other tasks needed for their care. This creates a feeling of not being important to the healthcare community. Case managers help empower patients to feel like they have someone to help with navigating their medical needs. The patients that say “my daughter/son/granddaughter/grandson is a nurse,” often have a better team to responsibly advocate, educate and coordinate for their family. My goal is for every senior to have a nurse case manager in their corner to be that person they can go to for help navigating the healthcare circle. To help the seniors in Michigan is one of my main reasons for starting a nursing case management company.

As primary medical care continues to transform, nursing has become a key component to the support, management, and success of caring for the elderly population. Case management is a path for nurses to use their knowledge base to treat the whole patient, often becoming the right hand to medical offices. With the increasing field of nursing entrepreneurs, more nurses are choosing to become independent of the large corporations that often are limiting to the field of case management by staff shortages and nurse to patient ratios. Now is the time for nurses to step out of the safety zone and continue to grow the field of case management making a difference with senior medical care.

Many different studies have proven utilization of nursing case managers have shown to not only improve outcomes, reduce healthcare spending, increase safety, but also improve quality of life. Patients, families, and caregivers express their gratitude for guidance. Owning a nurse case management company has allowed me to witness many positive results that leave a nurse feeling rewarded. Even if the interaction is just to check on the client by telephone, it is making a difference for the geriatric population. By showing compassion and being accountable to the client’s concerns, we can gain a senior’s trust and be effective in helping bridge the gaps from physical, social and cognitive limitations to medical concerns. Telephonic nurse case managers can reduce adverse drug events by reviewing and educating about medications, they can reduce unnecessary hospitalizations and ER visits, decrease healthcare spending and increase mortality with guidance and support. Case managers’ efforts can be seen across the communities.

I celebrate this week with my fellow case managers and thank you for being that special person that critically looks at the whole person and their needs. You are valued and a true asset to the field of nursing. Whether you work for a large or small hospital, insurance company, medical office, government agency or a small company like Care Resource Team, without you there are millions of people that would be lost and or forgotten by the healthcare system. Be proud and know you are appreciated for what you do!!!

Guest post from Jerri Medved RN, MSN, CCM, submitted as part of our “Case Management Is… Contest” and selected as an Honorable Mention!

Jerri Medved resides in Michigan, she obtained her Bachelor of Science in Health Care Administration from the University of Michigan- Flint as well as a Bachelor of Science in Nursing from Oakland University. She also holds a Masters in Nursing Education from Spring Arbor University. Jerri has a wealth of nursing experience. She started her nursing career in cardiac critical care. She has gained a wide variety of experience by holding positions in the acute care settings as well as home care, case management, utilization review, clinical documentation improvement, and assisted in the development of onsite and telephonic care transitions to home for a major insurance company. In recognition of this, Jerri was awarded the P.I.E award for Performance in Excellence. She also held a position on the wound care committee for St. Joseph Mercy Oakland Hospital. She has taught nursing education at Baker College, Oakland, and Chamberlin Universities. Jerri won the “Be Remarkable” award at St. Joseph Mercy Oakland in February 2018 in recognition of going above and beyond in assisting with complex case management.