What is care management? I work as a Transitions of Care CM for a Medicaid MCO in Kentucky, the 46th poorest state in the US. To me, care management is helping a member who has been beaten by a boyfriend after having a stroke find stable, safe housing. It is helping an infant who was exposed to substances in utero and discharged to an ill-prepared family member get the support they need to make it a successful lasting placement. It is helping a gunshot victim piece their life back together in their newly traumatized and now physically impaired body. It is helping a homeless member connect to community resources that help them put food in their mouth and access medication. It’s helping a family get a handicap van so they can access the community in ways they have never been able to before.
Case management is also losses. It is logging into my computer in the morning and realizing the member who I helped get into rehab last week, overdosed on heroin yesterday. It is relapses in pediatric cancer. It is denials of DME. It is yet another change and another place to document. It is chasing down providers to get the prior authorization. It takes flexibility. A deep breath. And teamwork.
Care management is mobilizing during a pandemic to help members access the ever-changing processes in the health care world and helping them say goodbye to family members from a distance. It’s bearing witness to their heartache.
Care management means being a jack of all trades; knowing payor sources, community resources, models of care, reimbursement structures, etc. It is knowing young and old, rural and urban. It is building relationships and networking with physicians, discharge planners, and DME companies. When working with people, the issues faced are as diverse as the members themselves.
Care management is celebrating the true successes like when a member achieves autonomy and meets their health goals.
It’s busy, it’s messy and at times overwhelming, it’s documenting and then documenting it again.
It is getting up every day and helping problem-solve with the people that live in my community. It helps me count my blessings, make a difference, and know I am helping better the lives of those around me. COVID-19 has brought a lot of chaos to all of us, but being able to work from home and model nurturing, compassion, problem-solving, and grit to my children has been a blessing in disguise. It is knowing what I do matters and that at the end of the day, I have made a difference in my community.
Guest post from Victoria Chanda, CSW, submitted as part of our “Case Management Is… Contest” and selected as an Honorable Mention!
My name is Victoria Chanda from Lagrange KY. I have been a social worker for 20 years in the field of intellectual disability and Cystic Fibrosis. Currently, I am working as a Transitions CM for a Medicaid MCO. Prior to social work, I was a rappelling instructor. Now I’m a mom to 2 great kids that keep me super busy!