By Gary Wolfe, RN, CCM, FCM

One day, I received a telephone call from a colleague I had worked with.  Shortly into our conversation, I was asked:  Do you want a job as a case manager?  My response was:  a what?  My colleague explained that this new company was starting to manage patients who were sick and complex and/or expensive.  I would be a nurse case manager and telephonically work one-on-one with each assigned patient and their health provider team to manage costs and ensure they achieve desired outcomes.  My immediate response was: let me think about it. 
 
I had already had a successful nursing career.  I have done all the usual things in nursing:  I am a staff nurse, head nurse, nursing supervisor, and nursing director.  I have worked in a variety of settings:  acute care, both academic and community medical centers, ambulatory care, hospice, home healthcare, and long-term care.  I had seen the good, the bad, and the ugly but had a strong sense of what constituted good care.  Did I have the knowledge, skills, and desire to be a case manager?  Could I build on my nursing foundation and do something new? 
 
I gave a lot of thought to becoming a case manager.  I analyzed my knowledge and skill set.  I was well organized, a quick learner, and a good communicator.  I was flexible and sometimes got bored doing the same old thing.  I had worked in various healthcare settings, so I could see and understand what was available at different levels of care and what patients benefit from.  Would I miss bedside care and working various shifts?  How would I explain what I do since I had never heard the term case manager, and I was sure many others were in the same situation?  Did I want a change?  What new skills must I learn, and how would I be trained? 
 
After a relatively short period of time, I made a decision. Yes, I would become a case manager.  The overriding factor in making that decision was that I wanted to ensure patients received the care they wanted and needed regardless of all the system and payment challenges.  I immediately started thinking about what new skills I would need.  First on the list of skills was enhanced negotiating skills.  Sure, I had negotiated many things, particularly between individuals, but primarily on a simplistic level.  I needed more computer exposure because electronic medical records were just being introduced when I first became a case manager.  I needed access to good medical references because I was sure I would not be familiar with all the diseases/conditions I might manage.  Where would I find support when I needed help? 
 
On my first day, I remember going to the new office excitedly.  I arrived and told my colleague who had originally called me about this position and said:  I am here for my orientation.  My colleague smiled and said well, come along.  For the next little while, my orientation consisted of sitting with my colleague, observing, listening, and reading. I was in a crash course on health benefit plans, rights, appeals, benefits, out-of-pocket, and maximum lifetime benefits.  The list just kept going on and on.  I felt good about my nursing knowledge and skills, but there was a lot more to case management, including always explaining to the people I was talking with who I was and what I was doing.  I quickly had a mental script that would start almost every conversation so people understood who and what I was doing to help. 
 
This was my introduction to my journey in case management.  It was a tremendously rewarding and challenging journey.  I have seen a lot of changes in case management.  Early on, much of my focus was on negotiating prices/discounts and care.  Now, case management is managing the complexity of care with an eye on cost, but networks and contracts have addressed more of the cost issues.  Certification has elevated the standards for case managers.  My professional organization, CMSA, has published Standards of Case Management Practice and is recognized in so many venues for being the voice of case management.  I have met so many amazing case managers from all over the country who have reinforced that I made the right decision to become a case manager.   

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Bio: Gary Wolfe, RN, CCM is the Editor-in-Chief of CareManagement. A past president of CMSA as well as a CMSA Chapter leader, Gary has significant leadership experience in managed care organizations. Currently, Gary's focus is on improving professional case management practice through education.