By Joyace G Ussin, MSN,RN, BSBM, CCM
In 1999, one of my church members came to me and said, “You’re a Nurse, right?” I responded proudly, Yes, and I love doing what I do! “Well, I work in the Insurance Industry, she said, and we are looking for Nurses.” It’s an “easy” job! “All you will have to do is meet with injured clients, their doctors, and lawyers and help them return to productive employment. The Nurses don’t do much at my company, she said. You should come?” That was the beginning of a career change from hospital nursing to becoming a Superhero! My forever Motto is “Case Managers are the Superheroes of Healthcare”!
Just as my friend misconceived the role of RN Case Managers in the Insurance industry, the Nurses on the hospital floor often come asking about openings in the Case Management department because they are “looking for an easy job”! You can laugh out loud right here. Kudos to those of us who have become so competent in our role that it appears to be an easy job to the average person! Most Case Managers, as I do, pray all day that we can make a difference as we find resources, negotiate with providers and insurance companies, act as advocates, and assist in the coordination of safe transitions of care for every patient we encounter while being fiscally responsible for costs for the institutions. And that’s just before our lunch break if we take one. It is far from an “easy job”!
Our colleagues observe the Case Manager going into the patient’s room to perform an assessment and do not realize that we are not only using our bedside skills to perform an accurate evaluation of the patient, but also considering LOS, appropriate bed status, avoidable delays, goals of care; support systems; community resources; insurance benefits; potential discharge needs, and safe transitions of care. I’ll repeat, it’s far from an “easy job”!
Case Managers are not just Superheroes but also Ninjas of Healthcare because even if you don’t see us, we fight daily to pull out wins and victories where it may have seemed hopeless! Advocating for that uninsured person and finding resources where there really seemed to be none.
Every Case Manager worth their weight in salt knows exactly what I am referring to. One example came last year when I was working with a 39-year-old professor from Indiana who was diagnosed with Multiforme Glioblastoma. His wife had been with him most of his hospital stay but eventually had to leave to return to work and take care of their two young daughters, who were being looked after by neighbors. Both college professors had exhausted all their resources over the years in this fight against Cancer. The patient was recently uninsured, declared beyond treatment phase, and stuck in Texas, alone! The referral for the Case Manager was “Home Hospice.” Therefore, I began the “easy” job of coordinating charitable hospice care in Indiana and negotiating transportation from Texas to the patient’s home! By the Grace of God, and because of great partnerships, I was able to secure ground transport, free of charge. I worked with an excellent agency in Indiana that not only provided at-home care but inpatient care at no cost to the patient. The patient made it home for his oldest daughter’s birthday and celebrated his birthday before succumbing to his disease.
Case Management is not an “easy” job, to say the least. However, it is one of the most rewarding roles that I have fulfilled in my career! Therefore, the very next time someone approaches you about the “easy” job of Case Management, you have my permission to rip open your shirt or blouse and display that “S” on your chest! Or just politely offer them a brochure of Case Management duties and………walk away! Or Fly, if you prefer! LOL!
National Case Management Week 2024 is October 13-19—Get ready to celebrate the heroes of healthcare—our Case Managers! This year’s lineup is packed with FREE CEs, including bonus October webinars, live networking events, amazing prizes, and so much more! Register Here: https://cmsa.org/about/national-cm-week/
Bio: Joyace has over 40 years of nursing experience with tenure in multiple specialty nursing areas including but not limited to: case management, oncology, intensive care, post anesthesia care, orthopedics, geriatrics, and pediatrics. Masters-prepared, she has educated and mentored countless nurses throughout her career who have become valuable contributors to nursing in multiple institutions. In her current case management position, Joyace is a member of the Unit Practice Congress which develops, implements, and enforces guidelines that foster quality coordination and effective case management principles. She also participates in the Sunshine Committee which highlights individual contributions of Case managers; promotes health and wellness tactics; cultivates mental well-being, and nurtures self-care. She is a member of the Case Management Society of America where she serves on the Board of the Houston/Gulfcoast chapter as a Board Member at Large. She is celebrated among her peers and is often sought out for her ideas and problem- solving skills. Joyace is a published author of The Power of Positive Words (2019, Westbow Press) and has a published abstract in the Journal of PeriAnesthia Nursing, which she presented at ASPAN (2015).
Fabulous job Joyace and so true to the point!!! I thought also it would be an “easy” job and where I started it was truly an easy job because all I did was sit on the phone all day and answer phone calls from the nursesin the Texas prison system with injured inmates that needed to go the ER. I directed them to the nearest ER and received clinicals and documented them in the system and was done. Then on to the next phone call. It was when I went inpatient which was my initial contact with Sue Wilson. But anyway, inpatient CM was completely different from sitting on the phone all day. It was hard and once I learned the ins and outs of the job, it was easier, but it was never the “easy” job that I thought it would be, however, it has been very rewarding over the years. I love working with you and rest of the MD Anderson CM team!!
As Joyace stated, the job of a CM is often misunderstood. I have seen all types of requests, even going as far as what to do with a dog at home because a pt was admitted. Regardless the need, CMs figure it out! We do a lot more than people know. Additionally, you are expected to be a clinical expert and not only understand the regulatory requirements of your job, such as Conditions or Participation, Joint Commission, insurance rules etc. CMs must understand the disease process, course of care and anticipate other medical needs. One thing I would love to see is more education to the end users about this role. It always amazes me when someone asks “how do you know all this” it is because I AM A CASE MANAGER!
Great article. I appreciate your hard work and diligence in describing some of the things that CM encounter daily.