Role clarity in case management
There has been much discussion about creating role clarity within the case management discipline. With new attention on the care continuum, many new roles are being created to both complement the comprehensive needs of patients and ensure that licensed individuals have the opportunity to work at the top of their license. As a result, many organizations are adding positions called navigators (not to be confused with nurse navigators) or health coaches to provide more support to the patient and family around the logistics of care.
Today, it is possible to go to two different health systems and find individuals who are doing the same level of care functions but who have completely different titles. This can lead to confusion, and it is important that the patient, family, and interdisciplinary team understand the role of everyone on the care team.
Use the following guidelines for defining roles at your facility:
- Inpatient/emergency department
- RN case manager: Medical discharge planning, patient progress, and care coordination. Utilization management if using the Dyad Model.
- Clinical social worker: Social discharge planning, crisis intervention, adjustment to illness, connection to mental health providers.
- Case management assistant: Placement, transportation, follow-up appointments, entitlement program support (including pharmaceutical assistance programs).
- Utilization management nurse (if using the Triad Model): Surveillance of medical necessity, resource management, regulatory compliance.
- Ambulatory setting
- Ambulatory RN case manager: Planning and coordinating in primary care sites
- Clinical social worker: Psychosocial support, crisis intervention, connection to mental health providers
- Nurse navigators: Planning and coordination for episodic care and chronic care, as well as disease management
- Health coaches: Support through home visitations/telephonic screening/community resource coordination
The role of the ambulatory case manager is relatively new and emerging with new practice standards, but the traditional roles of case managers and social workers within the inpatient settings must transform as well.
Editor’s note: For more information, see Longitudinal Case Management: Designs Across the Continuum of Care.