Executive Summary

Success as a case manager requires a creative personality and good communication skills, case management experts say.

• Case managers need to anticipate the unexpected and solve difficult problems.

• Teamwork is a top priority and necessary skill in today’s healthcare arena.

• Case managers also need to understand things from the patient’s perspective in order to help patients overcome barriers to better healthcare and adherence.

 

Case and care managers need to be multitalented to succeed in their challenging roles. Having some background in nursing or social-behavioral science is important, but so are additional skills that have to do with how they work within an organization and whether they can find creative solutions in a low resource situation, experts say.

From a decision-maker’s perspective, finding highly qualified and talented case managers takes time, says Peggy Crabtree, RN, MBA, vice president at The Camden Group, a healthcare management and consulting firm in Los Angeles.

“You learn more from the interview,” Crabtree says. “I have [care manager job applicants] do most of the talking, describing situations where they solved a problem for a patient and giving examples of the things they did.”

Crabtree wants to know how well they communicate and how much they know about a particular disease process.

“I will say, ‘Tell me about a time when you were very creative in solving the patient’s problem,’ or, ‘Talk about a time when you were a great team player,’” she says.

As healthcare evolves, so do the skills needed by people working in the field, and this is especially true of case managers, says Bridget Gulotta, RN, MSN, MBA, senior consultant at The Camden Group in Chicago.

Skills and qualities

Gulotta and Crabtree also offer the following ideas of the skills and personal qualities case and care managers need to enhance and develop their careers:

Creative personality: Case managers have to anticipate the unexpected, be creative in their work, and remain resourceful, Crabtree says.

“Traditionally, hospitals would put people into care management roles when nurses couldn’t perform services any longer at the bedside because of some kind of medical limitation,” she explains. “We’ve seen a real transition away from that because the skills you need in this day and age are so different.”

Healthcare and case management are too complex now, she says.

“You can’t just take anybody and put them in this role,” Crabtree says. “If you really want to develop a strong program, you have got to make it important to the organization, seen as a priority, and you need to constantly provide education and focus for people in that role.”

Teamwork: “We’re moving away from individual practitioners to working across the healthcare continuum, breaking down silos,” Gulotta says. “Teaming is a huge change: understanding both organizational and cultural interventions that case managers can provide to populations.”

Case managers work with healthcare teams because the people at the bedside are the ones who know what patients’ barriers are, Crabtree says.

“Care managers work as facilitators on the team,” she explains. “They decide how to redesign processes of care to bring the best value to the patient.”

Patient-centric care: Case managers today need to understand patients from both the clinical perspective and also from the social determinate perspective, Gulotta says.

“This includes everything from whether they are homeless and living in poverty to mental health issues, transportation issues, and anything that could be affecting their health that a practitioner should not or could not see in front of them,” she explains. “What’s also very important is disease management and co-management of multiple conditions.”

Engaging patients in self-management: Once upon a time, there were limitations in how case managers worked with patients in self-management. It’s changed: Now this is a big part of some CMs’ jobs, Gulotta says.

“Previously, it was asking whether patients understand their medications and get themselves to the doctor,” she says. “Now, it’s more. For example, a patient with heart failure needs to be educated about the disease, but it’s also up to the patient to take daily weight measurements and to monitor whether there is shortness of breath.”

Patients need to recognize their own red flags before they get to an exacerbated state and need to be admitted to the hospital, Gulotta adds.

“Before the patient gains four pounds or can’t walk to the side of the bed without shortness of breath, he needs to call the care manager, who can help increase the medication and help determine whether the patient needs to see the physician,” she explains. “These are all preventive actions so the patient doesn’t have to be readmitted.”

Workflow flexibility: Today’s case manager needs to be open to change as it’s unlikely healthcare will evolve and then settle into one comfortable model.

“Case managers have an opportunity to move into care redesigns as we move into the post-acute world,” Crabtree says.

As providers, payers, and other stakeholders work on initiatives involving things like bundled payments, case managers have to remain flexible with workflow changes, she notes.

“They’ve done the same thing the same way for many years, and it’s kind of worked,” she says.

But that’s no longer true. The healthcare industry is engaged in sweeping care redesign to correct some of the most common problems of the traditional approach to patient care, including redundancies, poor communication and coordination between health settings, and barriers to reducing hospitalizations and emergency room visits, Crabtree says.

The new motto is: “Right care in the right place at the best value for the patient,” she says.

“So when you talk about care redesign, it’s looking at different workflows and taking care of patients, whether they’re in a doctor’s office or ambulatory setting or with a health plan,” she adds.

The case management background well prepares CMs for navigating care redesigns or even leading and managing redesigns, Crabtree says. “There are opportunities to redesign patient care in any setting where a patient is.”