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CMW Tip of the Week: Nailing down a case manager's job responsibilities

Case Management Weekly, July 9, 2008

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This week’s tip is an ask the expert with a question provided by Case Management Weekly reader Vicki Wittland, RN, BSN. The answer is provided by Randi Ferrare, RN, BSN, MHA, MEd, the president of Optima Healthcare Consulting, LLC.

Q: It seems to me as if the job responsibilities vary widely from facility to facility for RNs employed in the care management departments, even though the actual/written job description is very similar from facility to facility. What is your opinion of the job description of the RN case manager? I suspect the difference could be if there are adequate social workers (SWs) on staff, as it seems many CMs are picking up this role at some facilities. I also hear—and experience firsthand at my facility—that a big part of care managers’ time is being spent with the physician and on the telephone assessing and reporting the patient’s condition, test results, and response or lack of response to treatment. I have been wondering if the care manager is taking on assessment and reporting (critical thinking) that should be being done by the bedside nurse.

A: As you are probably aware, there are many different staffing models for case management. The most common one is a department made up of RNs and SWs. More often than not, there are separate job descriptions for each discipline. The lines of responsibility sometimes blur—a sudden staffing issue or program redesign usually causes this. Job descriptions sometimes lag behind the changes. Depending on the staffing model, the actual job duties for the RN case manager can vary. If there is an even complement of RNs and SWs in the department, usually the RNs focus on utilization review, resource utilization, and overall management of the case. It is rare that a SW does the UR, but I have seen that model with well-seasoned SWs. There really is no easy answer or a cookie cutter program.

As far as your part of the question regarding RN case managers spending time with the physician, looking up test results and treatments, I think this is part of their job. This is necessary to move the patient through the care continuum. However, you are correct; it does appear that the bedside nurse should be on top of these issues. But the reality is case managers can have a huge impact by “case managing” and staying on top of the patient’s progress toward discharge.

Have a question for our experts? Email it to editor jmcginley@hcpro.com. Your question could be featured in the next issue of Case Management Weekly!

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