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Case
Managers Make Sense of the Healthcare System
by Maryann Hammers
The healthcare system is tough to navigate. It's complex, confusing and complicated by
a tug-of-war among policies, providers and payers.
If you're an experienced clinician and would like to do more to come to the patients'
rescue, consider a job in case management. This field offers practitioners challenges,
autonomy and the feeling that they actually improve people's lives. "Case managers
are, first and foremost, patient advocates," says certified case manager Kathleen
Moreo, R.N., president of Case Management Society of America in south Florida. "We
make sense of the convoluted health system for patients."
The case manager's role
Case managers may be disease-focused, acute-care-focused or wellness-focused. They may
concentrate on pediatric care or elder care. They may specialize in rehabilitation,
behavioral health or anything in between. But regardless of the setting or the specialty,
all case managers serve as educators, facilitators and resources as they coordinate the
providers, services and products that help patients and their families.
In a typical day, a case manager may do any of the following:
Assess patients' needs to identify problems.
Create care plans.
Coordinate and arrange for medical and home-health services.
Make referrals to community resources and programs.
Provide crisis intervention.
Provide education to help patients and families make good choices.
The bottom line? "Case managers have the ultimate goal of providing quality care
in the most appropriate setting in the most effective manner," Moreo says. "We
are concerned with access to care, cost and quality."
Breaking in
The field of case management began exploding during the past decade with the advent of
managed care, and it shows no signs of slowing. You can find case managers in private or
public agencies, the military, home-care settings, hospitals, HMOs or at insurance
companies.
The average case manager has many years of clinical experience. About half have
masters' degrees. They also continue their education by attending conferences and reading
journals. So it's important to remember that "case management is not for
beginners," says health-care recruiter Tom Armstrong of the Stewart Group in Ponte
Vedra Beach, Florida. "You generally need a minimum of three to five years in an
acute-care setting. You need to be familiar with community resources and to understand
disease processes and clinical applications."
Armstrong notes that over the past few years he has noticed a greater demand for
specialized case managers as opposed to generalists. "Some of the hottest markets for
case managers are in workmen's compensation, industrial relations and OSHA
compliance," he says. "Integrated delivery systems and large hospitals are
looking for people who are trained in highly specialized areas such as catastrophic head
injuries, neuro-orthopedic -- even burn care."
Looking for your first case management job? "Managed-care companies provide an
excellent training ground," Moreo says. "You'll have the opportunity to deal
with patients from birth to death -- which you may not be able to do elsewhere."
Resources
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