“We Don’t Know What You Do…”

This line, frequently uttered by a physician, is a bit of a running gag my bosses would rather me not mention. In New York state Patient Centered Medical Home (PCMH) is still relatively new.

When the role of clinical care manager was conceived, it did not come with a definitive list of responsibilities, rather an outline of what the position was meant to accomplish.

That role is evolving monthly and that can confuse patients and other members of the health care team that want to understand the best way to utilize a nurse clinical care manager.

I would not be surprised to hear from another care manager that their responsibilities differ, but here are the main functions of the nurse clinical care manager:

  • Increase quality of care for patients
  • Minimize and prevent (re)hospitalizations
  • Save the network money

How care managers go about achieving that aim is what has many co-workers scratching their heads.  Here are some of the elements that should start to bring the picture of, “what we do” into focus:

  • Analyze data to recognize and address health care trends
  • Analyze site metrics (hypertension, diabetes, immunizations, etc) that determine physician reimbursement
  • Monitor patients going in and out of the hospital to insure their transitions of care are safe, preventing (re)hospitalization
  • Collaborate (with physicians, office staff, data coordinators, specialists, home care, community resources, families, nurses, social workers, pharmacies, etc) to determine the best plan of care for each patient
  • Educate patients and families to help them manage illness, chronic disease, and health promotion
  • Connect patients to community resources
  • Help patients navigate complex health systems
  • Create new work flows to increase efficiency of health care administration
  • Manage both the patient population that visits the office AND the population that does not

These elements are a good starting point for understanding the variety of responsibilities of a nurse clinical care manager.  It is a fantastic nursing job for anyone that enjoys collaborating with other health professionals, educating patients, and desires the creative freedom to improve patient lives.

I am extremely interested in hearing from other care managers on what their job looks like and what they think of the position. All other questions and comments welcomed.

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