By Jeni Miller
Case management is not an ancient profession. Most professionals date it back to the mid-1970s or early 1980s when insurance changes necessitated expert navigation.
As the role of case manager developed, so did the expectations and dreams of how these professionals would be trained to excel in their role.
“We perhaps had a bit of a Pollyanna attitude that this would all fall into place,” says Mindy Owen, RN, CRRN, CCM, principal of Phoenix Healthcare Associates. “We thought there would be courses in the universities that would be strictly case management-focused and that we would get a place in employer orientation specifically on how to provide case management initiatives and practice. Instead, it often happens that in many places, either you shift into a case management role or you’re asked to shift into one, but once you get in and figure out what it’s all about, it’s a lot of heavy lifting from what your knowledge base is as a nurse or social worker.”
Owen explains that, largely speaking, it is the case manager’s responsibility to proactively build up their body of knowledge, but they sometimes are grasping for educational tools to get up to speed quickly. While some schools offer a case management curriculum in their academic program, and some hospital systems allow their leadership to build a strong case management orientation, it is not true everywhere. With other specialties, it is more typical to undergo advanced training before the professional enters the specialty role, and as they continue.
“There were a lot more steps, and maybe we were naïve, but we truly had to have more published and built up before case management was looked at as a specialty in the academic world,” Owen recalls. “And it is a specialty. I can’t work in a NICU, for instance, because I don’t have a knowledge base for that.”
Organizations like the Case Management Society of America and Commission for Case Manager Certification have come along to provide tools and self-study, but case managers first have to know about those resources to get the education they need.
In particular, case managers need to be solidly acquainted with the financial aspects and sustainability of health systems, Owen says. This comes with a steep learning curve due to state and federal rules and regulations that encompass healthcare. In addition, Owen notes new case managers would be better served if they had a clearer picture of what would be expected of them before stepping into the role.
With many aspects of the case management role not apparent until after the position is filled, it is no wonder employee retention issues run rampant in the industry.
“People come into this with a naïve thought process that they can just plug in and do it,” Owen says. “Many people come in not really understanding what the job is really about. Sometimes, they’ll come in and their eyes are opened, they’re shell-shocked, and then say, ‘I don’t want to sign up for this.’ Now you’ve hired someone who is going to leave you.”
With more focus on the tools to develop the practice of case management, new case managers would have a better idea as to whether they want to work in this specialty, and for a significant amount of time. This is critical because of recent “difficulty in retaining good people in case management for a long time, and especially with the pandemic,” Owen notes.
Toni Cesta, PhD, RN, FAAN, also sees how a mere quick training in case management can lead to low satisfaction and high turnover in the department.
“Many case managers move into their role with very little foundational knowledge in case management and its related topics,” explains Cesta, partner and consultant with Case Management Concepts. “Some may receive a basic ‘how-to’ orientation from another case manager, but do not understand the ‘why’ behind what they do. When this happens, their work becomes a series of tasks. This can lead to burnout and turnover.”
To avoid this burnout and turnover cycle, Cesta recommends education for case managers include:
- A foundational series of classes in case management geared toward RN or social work case managers, covering reimbursement systems, utilization management, discharge and transitional planning, compliance, coordination of care, avoidable delay management, outcomes, and other topics;
- A preceptorship with another case manager with weekly goals;
- A small assignment to start that is expanded over time.
Other topics that might be covered include federal, state, and healthcare plan regulations; overall financial responsibility; advocacy; social determinants of health; ethics; and communication skills, Owen says.
Education for the case manager, regardless of whether they are new to the role or have decades of experience, is an even more pressing need as the healthcare industry becomes increasingly complex and overwhelming.
“Often, the patients themselves don’t know what their health plan covers. If that is overlaid with a factor like depression or a lower socioeconomic status, it becomes even more difficult,” Owen says. “Meanwhile, through the pandemic, we have some case managers who work from home, others who are only on site, and as we come out of that we need to ensure better workforce development or we may not end up as strong as we should be.”
One way case managers could approach this better workforce development is through seeking certification.
“Case managers should seek certification in the field of case management,” Cesta notes. “Not only does this certification identify them as an expert, but it also requires yearly continuing education. In today’s healthcare environment, things are changing rapidly and often. Without continuing education, a case manager will lose that ‘why’ that drives the work that they do. The theoretical framework of our work is essential in the movement of a case manager from novice to expert.”
Case management is an “advanced practice,” Owen notes. “Those who are case managers are healthcare professionals who have a responsibility to enhance their individual knowledge base. I believe it is important for both an organization and a healthcare professional to partner in enhancing their training/education.”
Much work is needed in building a clear understanding and collaborative support with senior leadership, human resources, and those making hiring and training decisions for case management professionals, Owen adds.
As opportunities continue to present themselves, case managers should participate as often as possible for personal career growth, encouraging others in their profession to do the same. Case management leaders should advocate for those in their department, ensuring these opportunities are available and reimbursed.
“Several universities have implemented online or in-person case management master’s programs as well as post-master certificate programs,” Cesta says. “Many of the live conferences have moved to a virtual format, and these are always available to case management professionals and should be taken advantage of. Additionally, case management leaders may choose to budget for a program for their staff that is individualized to the hospital and department, and taught by a consultant who is knowledgeable in these topics.”