Stories from Case Managers in Honor of Case Management Week…

My name is Stacey I am a case manager, and have been in my position for approximately 10 months. I am new to case management and I have gained a wealth of case management knowledge. But I must say the most rewarding thing about my experiences is that I am able to maintain my compassion for being a RN and advocate for my patients. 

A most memorable moment as a case manager and a life lesson is one of a recent experience I had on my assigned unit. I had a patient with a specific managed insurance that normally, 98% of the time, denies and does not grant authorization for acute rehab. The patient was refferred to acute but did not meet the obvious criteria so I was told by the team that the patient should go to SAR because “her insurance won’t give authorization anyway.”

I met with the patient because the social worker stated the patient had some insurance concerns. I met with the patient and she really wanted to “bounce back” and receive acute rehab. She became very anxious when she was told that she would not get into acute rehab because of her insurance. I listened and heard her cry and went through her chart and found a qualifing factor: neurological defict that was a new onset event post op. I advocated and presented this to her insurance asked them to please consider this case.

That afternoon I received a call she was granted approval and authorization was given. I met with the patient again and informed her that she had been granted authorization for acute rehab and that she would be discharged there. She became tearful and gave me a big hug. She was thankful which made me feel like that bedside nurse I will always be in my heart. I learned that case managers play a significant part in the admission stay and discharge of patients. I learned that we are dependent on by many, number one: the patients. It was rewarding to put a smile on her face and play the role of patient advocate; as I feel a nurse should be.

Stacey