In Case Management, we “get to know” a person from a different perspective, far more than a simple lab test or a physical exam.
When a person works in the healthcare field, particularly the Case Management field, the aspects that go with it can be holistic, specialized, and focused. I remember when I first entered the Case
Management profession, a lot of people were asking me what I do again. Even Registered Nurses that I meet for the first time who have worked in bedside nursing for a while wanted a further explanation of
what I do because it creates curiosity within them. Defining what Case Managers do can both be simple and intricate depending on the audience and listener. In a simple definition, case managers can be
translated literally, which means “a person managing a case”. A bigger and more in-depth connotation can be best described as aiding people who have the greatest need. These needs may come from high-risk individuals, vulnerable populations, high utilizers of health care services, people who have been non-adherent to treatment, and people who need access to resources. Other times, the need may not
arise from the individuals mentioned above but also from healthy individuals who need assistance in sustaining their health, wellness, and vitality. With the rising cost of health care and the global
healthcare crisis, Case Managers are needed now more than ever.

A resident with a history of trauma asks for help finding a female dermatologist who accepts both Medicare and Medicaid so she will not have any out-of-pocket expenses – but not with this particular county medical group or any of their satellite clinics because they give horrible service. I run my Google-fu and find a couple of possibilities, but only if the resident’s primary care doctor can get prior authorization from Medicaid for the referral. I pass the information on to the resident and wish her the best of luck. 

When an aging veteran’s rep payee/caregiver takes the battery from his motorized wheelchair for three days as “punishment”, leaving the veteran unable to get to the grocery store or any food place to feed himself after previously only being able to carry 2-3 days’ worth of food home on his wheelchair at a time, I make the call to adult protective services. I also advocate with this resident’s external case manager numerous times over several months for a higher level of care due to the resident’s inability to meet his own needs in fully independent living and decreasing quality of life. The day before Thanksgiving, a substitute case manager filling in for the holiday week sees what I see and transfers him to the hospital, then finds him a place in hospice. My resident is literally dying while his primary case manager ignores or placates me for months; it took a substitute to hear and believe. The resident passes before the turn of the year but at least his last bit of time is comfortable.

1. Miracle workers: we pull rabbits out of hats we didn’t know had rabbits!
2. Peacemakers: we smooth out the roads between obnoxious uncooperative providers and our
injured workers, other providers, adjusters, claims examiners, team managers!
3. Bridges: we lay ourselves down like bridges over troubled waters to get our injured workers to
appropriate providers within days instead of weeks even when they’re not taking new patients,
back to work modified duty when their restrictions would prevent anyone else from even being
in the vicinity of a workplace, and back to society and their communities to enjoy life again!
4. Multi-taskers: we eat, drink, type our notes and reports, talk on the phone to injured workers
and doctors’ offices, organize our desks, pet our dog, and answer our spouse’s questions about
the weekend all at the same time!

Strength, intelligence, and sheer determination combined with creative thinking and sprinkled with empathy.  These are some of the most admirable traits of Marvels’ famous “Avengers.”  Comprised of those with sketchy criminal backgrounds combined with physical size and physical ability extremes, they work together to battle an unjust system to promote peace. 

However other, less famous professionals work together to battle a fragmented system embracing special populations with similar physical extremes.  These compassionate professionals creatively plan for those with similar interpersonal challenges.  Those superheroes call themselves another name; those superheroes call themselves case managers.

While superheroes are born of untimely misfortunes and accidents, case managers are remarkably similar with their evolution.  From childhood encounters with hospitals, to those thrust into caring for aging family members, ill pets and farm animals, their upbringing plunges them into healthcare.  Others simply manifest a passion to help those in need, and become driven to find their niche in the human services industry.  Their educational backgrounds vary from multiple advanced degreed social workers to similarly highly degreed registered nurses.  Their individual skillsets make them creatively resourceful, highly skilled and irreplaceable.  Experience is one of their most valued and hard earned assets to ensure success and longevity in the profession.

As a nurse case manager in the NY Workers Compensation arena, I must switch
my flight plan often.
I will be going to visit an injured worker at a MD office, and I hit NY traffic,
where I begin to sweat, hoping I make the appointment in time, and the tension of
the thought of missing the appointment, makes me grip the steering wheel so tight
that my fingers turn white. In my mind I am going 60mph. But the speedometer
says 15 mph. In this scenario I am a Peregrine falcon, as this is the fastest bird.
On another trip I will attend an injured worker’s bedside in the hospital, (over 100
miles from my office) that took a horrible fall and suffered bilateral calcaneus
fractures. He cannot go home because he will be non-weightbearing for months.
So, in I swoop to locate the best inpatient rehab facility, that is close to his home,
close to his family, negotiate a good rate for the insurance company, and make