Kelsey Wallace

Case Manager Rotation

1. Describe the purpose of the case manager.

 The role of the case manager is to help prepare the patient and their
support system for life after discharge from the hospital. They also assure
the patient gets the best care possible while in the hospital, coordinating
the patient, nursing staff, the providers, and the home support system.
They are experts in gathering necessary resources to ensure the patient
has all the necessary aid and equipment to have the best quality of life
possible following discharge.

2. Discuss the jobs performed by the case manager.

 The case manager is responsible for verifying the patient meets criteria to
be hospitalized. They are to assist patients and family with legal
paperwork; DNR, Healthcare Proxy, assistance program applications. In
Meghan’s case, she is the overseer of the Community Paramedic Program.
The Community Paramedic Program is similar to Home Health, but a
nurse and a paramedic go out on home visits to see people who have been
discharged from the hospital and either do not have insurance, or do not
meet insurance criteria for Home Health. They assess the patient; teach
them necessary skills to improve their health in the home setting.
3. Describe the types of communication used by the case manger.
 The care manager uses verbal communication with all visits with the
patients. Face to face communication is necessary to ensure the patient
understands the information provided by the provider as well as the
nursing staff. Nonverbal communication is used to help the patient feel as
if they Care Manager is listening and is there to support them. Written
communication is also utilized, patients are given pamphlets with the
services provided the Care Manager and the number so she can be
reached. Distance verbal communications is also used when the patient’s
family is not able to be at their bedside, but is helping to coordinate care
after discharge.

4. Explain the teaching-learning procedure used when providing client education.

 The Care Manager must assess the patient’s ability to understand the
teaching provided. They also assess the needs of the patient, if they need
written material or if verbal communication is sufficient. The Care
Manager explains the process or necessary information and requests that
the patient or support person repeats the information or demonstration
to ensure they understood the teaching and material provided. If
understanding is not demonstrated they repeat the information using
more easily understood terms and phrases.
5. Explain the required credentials for working as a case manager in the acute care
environment.
 Integris requires the Care Manager in the rural hospitals to be an RN, and
have 5 years of diversified experience in the nursing field. They even
prefer the Care Manager to have their Bachelor Degree. In larger hospitals
they utilize the LPN in the Care Manager Role. Meghan is an RN with 6
years experience; she has worked on the MedSurg unit for several years,
ICU, Surgery, Express Care, and an ENT clinic.

6. Discuss potential obstacles related to cultural differences or language barriers.

 If the patient’s first language is not English the Care Manager may require
the assistance of an interpreter. Materials printed in the patient’s
preferred language may need to be utilized as well. Cultural differences
may present a problem by the patient not willing to communicate with
the staff preferring for their spouse to do so. Culture may also affect the
care a patient is willing to receive- i.e. not wanting immunizations or
declining blood transfusions.

7. Describe the duties performed by the case manager during the shift.
 Meghan started off the day verifying each patient meets the criteria to be
hospitalized. Determined how many patients were admitted over the
weekend. She then collected information about the services provided by
the Care Manager and her business card for each patient she had not
visited on Friday. She also printed information for assistance programs
for gas, prescriptions, and medical equipment. She returned phone calls
to set up appointments for the Community Paramedic Program. She took
phone calls from concerned parents with a sick child, but did not have a
ride to see a provider. She made transition of care phone calls to patients
recently discharged. She then met with Dr. Ratermann for Rapid Rounds;
he discussed all his concerns for his patients that he wanted Meghan to
discuss. She set up Home Health for a patient to be discharged, Hospice
services for another, and skilled nursing placement for a third. She then
met with 14 patients and their families, discussing their concerns,
services and equipment needed. During the assessment she asked every
patient: where they lived and who the lived with, if they drive and if not
how they get to the doctor or get groceries, if they are able to cook and
clean or if they need assistance, if they use any assistive devices or home
medical equipment, what pharmacy they use, if they take their
medications from the bottle or use a pill planner, who their support
system is, who will drive them home on discharge, and who their PCP is.
She discussed service change paperwork for a patient transitioning from
inpatient to observation. She set up oxygen therapy delivery for a patient
to have portable oxygen to get home and have a delivery to the home for
the patient when she arrives. She discussed Medicare appeal notifications
with all Medicare patients, because patients are to sign those at least
 twice if admitted to inpatient for multiple days. She set up outpatient
therapy appointments for a patient to be discharged. She contacted
several pharmacies attempting to get a patient financial assistance with
insulin, however, Integris is only willing to assist with $300 for
medication and the insulin the patient has been prescribed was over that
amount. She spoke with several patients, in the hospital and on the
phone, about the Christian Medical Clinic to provide affordable care. She
also pointed several patients in the right direction to get information
regarding disability.

8. Discuss your experience and explain how it will benefit you in your nursing
practice.
 The amount of time Meghan spent doing research to help each patient
receive their medication, home health services, oxygen therapy, gas
money, visits by Community Paramedic Program, and Christian Medical
Clinic services alone was eye-opening. Seeing her patience while visiting
with patient’s and families was astounding. Knowing how much
insurance coverage affects a patient’s resources for services following
discharge inspired me to provide even more patient education, to be sure
the patient and family are able to have the best quality of life as possible.

9. Compare the case manager role as described in the reading assignment with the
role you observed during this clinical experience.
 I feel as if I was not prepared for the amount of effort the Care Manager
puts into their job, even after reading the material. The material only
scratched the surface of the work the Care Manager does. While Meghan
verifies insurance coverage, hospitalization criteria, legal paperwork, and
coordination of care, she does so much more. Meghan visited with every
patient and their families and that alone took so much time out of her day.
When older patients, who were lonely, wanted to talk about different
aspects of their life she stood at their bedside and visited like she did not
have several more patients she need to see. The amount of time she spent
documenting her conversations with patients, families, Home Health
companies, providers, Hospice providers, and nursing staff was
incredible. Her caring nature and her obvious love for her patients was
inspiring.