1. Powell, Suzanne K. MBA, RN, CCM, CPHQ

Article Content

A quote I once read cautioned, "Don't confuse your career with your life." Indeed, the distinction may be a bit blurry if you are a case manager. But the quote made me realize that case managers are particularly fortunate individuals. Every day, they have the capacity to make someone's life better controlled, saner, less scary, or more hopeful. So when you are updating your resume, consider the "between the lines" part that remains unwritten. That is the part you will take with you, always.


On your resume, you may articulate case management roles and functions. However, if you examine case management at the roles, functions, and "domains" level, you may also see a fine line between the activity statements and the spirit of the work. Every 5 years the Commission for Case Manager Certification (CCMC) researches case manager roles and functions in order to capture the current state of case management practice (CCMC, 2005). This type of in-depth research is required in order to support an evidence-based certification examination in case management and has been highlighted in this journal (Tahan, Huber, & Downey, 2006a, 2006b). The Case Management Society of America (CMSA) defines case management as "a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes" (CMSA, 2002). Together, the definition, roles, and activities determined by these two premier organizations make impressive resume statements; yet without going deeper, we may miss the very heart of case management.


Resume Statement: Performs Client Assessment

Your resume may include the following: Reviews information about patient's condition (e.g., diagnosis, history, prognosis); identifies cases with high-risk potential for complications; interviews patient to ascertain baseline and ongoing level of physical, emotional, psychological, and spiritual functioning; assesses the patient's social support system and relationships (e.g., family, friends, significant others, community groups); reviews information about patient's social and financial resources (e.g., income, living situation, insurance); reviews the patient's health history to ensure that it is accurate and comprehensive; assesses for the presence of multicultural issues and health behaviors that may impact the patient's health status; assesses respite needs of patients and their caregivers.


Humanistic Statement

Because of you, your patient did not have to leave her assisted living "home." You see, the managers felt that she could no longer be at that level of care, as she was mentally "deteriorating." You realized that they were attempting to communicate with her while she was at a grave disadvantage. Once the hearing aids were adjusted, and the glasses were routinely given to her, her ability to communicate and follow directions dramatically improved.


Resume Statement: Provides Implementation and Facilitation of Services

Your resume may include the following: Implements the case management plan; communicates the case management plan to key stakeholders (providers, payers, employers, family, significant others); advocates for patients (e.g., negotiate extracontractual benefits, ensure adequate patient knowledge regarding medical care choices); plans for the patient's transition along the continuum of care; performs a cost-benefit analysis to recommend options for optimal treatments and services.


Humanistic Statement

The patient was a large woman, essentially quadriplegic due to advanced multiple sclerosis. Although she required 24-hours care, the husband adamantly refused nursing home placement. The wife was an extremely pleasant person; however, the husband was deemed quite "difficult." During one (of many) admissions, you approached him, touched his arm, and gently asked how long he had been caring for his wife in this condition. He looked surprised at your concern, but answered, "seventeen years." "And who," you asked, "takes care of you?" Breaking into tears, the man said quietly, "No one." Because of you, support was set up for the caregiver.


Resume Statement: Implements Planning and Coordination of Services

Your resume may include the following: Documents the implementation of the case management plan; implements cost-effective case management strategies; educates and/or facilitates the education of patients about wellness and illness prevention strategies specific to their condition; negotiates rates to maximize available funding for an individual's healthcare needs; coordinates the delivery of services funded by multiple payer sources (coordination of benefits [COB]); facilitates the implementation of advance directives (e.g., healthcare proxy, a consent to do-not-resuscitate [DNR] order, or a living will); establishes treatment goals that meet the patient's healthcare and safety needs as well as the referral source's requirements; identifies regulatory requirements pertinent to the case (e.g., secure and/or verify informed consent from the patient; release of nonpublic personal/financial and/or protected health information); reviews the conditions of the patient's insurance policy/policies (e.g., coverage, exclusions, extracontractual provisions); identifies eligibility for private-sector and public-sector funding sources for services (e.g., Medicare, Medicaid, community resources, charitable funds); organizes resources and integrates the delivery of healthcare services (e.g., arrange home health, necessary durable medical equipment [DME]).


Humanistic Statement

You have seen it time and again. At the final hour, the DNR/healthcare power of attorney is not available or the family refuses to honor the dictates. One poor decision leads to the saddest of prolonged life endings. But because of you, it did not happen to this family-and that family. Final transitions, although difficult, were not fraught with family in-fighting and anger.


Resume Statement: Implements Continuous Monitoring

Your resume may include the following: Maintains ongoing communication with key stakeholders (providers, payers, employers, family, significant others); conducts ongoing interviews and evaluations with patients and other members of the healthcare team (e.g., doctors, nurses, social workers, therapists, other stakeholders including employer and insurers); monitors the patient's progress in achieving the goals, objectives, and expected outcomes of the case management plan at specified timeframes; documents the patient's progress in achieving the goals, objectives, and expected outcomes of the case management plan; performs resource utilization-looking at all the resources available and the need/use for them; monitors utilization management activities (e.g., authorization for services, precertification for services, concurrent/retrospective review); monitors disease management activities.


Humanistic Statement

You speak to coworkers with respect and objectivity. Clinically, you are at the top of the game; physician/case manager discussions do not make you uneasy. And, most important, you always put the patient first. Because of you, case management is growing in respect and leadership. Because of you, case management is seen as one solution to the many current healthcare issues.


Resume Statement: Evaluation and Outcomes

Your resume may include the following: Communicates the patient's progress in achieving the goals, objectives, and expected outcomes of the case management plan to key stakeholders (e.g., providers, payers, employers, family, significant others); evaluates the effectiveness of the case management plan as it relates to the identified goals, objectives, expected outcomes, and specified timeframes; evaluates and documents the individual's use of and/or response to therapeutic interventions (e.g., medications, treatment modalities, specialized services, DME); evaluates the timeliness and availability of treatments and services (e.g., variance management); determines that case management services are no longer required by the patient; evaluates the impact of multicultural issues and health behaviors on the patient's health status and outcomes; collects and analyzes outcomes data (e.g., clinical, financial, variance, quality/quality of life, patient satisfaction) systematically on an ongoing basis; tracks and trends administrative activities (e.g., report timeliness; quality of service; timeliness of service; billing audits; documentation of time and expense); prepares reports in compliance with federal, state, and local regulatory requirements.


Humanistic Statement

And, yes. Case managers will lament that-in addition to all the other tasks-collecting data on these patient safety processes is time-intensive. But quality studies are the foundation of increased utilization of evidence-based medical care that moves the barometer of better patient outcomes and safety. A quote from the 100000 Lives Initiative humanizes this concept:


The names of the patients whose lives we save can never be known. Our contribution will be what did not happen to them. And, though they are unknown, we will know that mothers and fathers are at graduations and weddings they would have missed, and that grandchildren will know grandparents they might never have known, and holidays will be taken, and work completed, and books read, and symphonies heard, and gardens tended that, without our work, would never have been. (Berwick, 2005)


You do a lot!! And you do this all while maintaining the patient's privacy and confidentiality; adhering to ethical standards that govern case management practice and individual licensure or certification; adhering to legal, regulatory, and accreditation standards that govern case management practice; serving as an advocate for an individual's healthcare needs; and maintaining the patient's safety. You ARE a superperson!!


What you DO in case management is tremendously important. But what you ARE as a person who does case management, the strengths you bring to the patient and the family, is priceless. When you think about the resume of your life, no matter how long or short you have been a case manager, notwithstanding how old, young, clever, or creative you are-consider what Michelangelo said-and know that we all are a work in progress:


I saw the angel in the marble and I carved until I set him free.




Berwick, D. (2005). Overview of the 100,000 lives campaign. Retrieved February 10, 2007, from[Context Link]


Case Management Society of America. (2002). The standards of practice for case management. Retrieved January 19, 2007, from[Context Link]


Commission for Case Manager Certification. (2005). CCM certification guide. Rolling Meadows, IL: Author. [Context Link]


Tahan, H., Huber, D., & Downey, W. (2006a). Case managers' roles and functions: Commission for Case Manager Certification's 2004 research, Part I. Lippincott's Case Management, 11(1), 4-22. [Context Link]


Tahan, H., Huber, D., & Downey, W. (2006b). Case managers' roles and functions: Commission for Case Manager Certification's 2004 research, Part II. Lippincott's Case Management, 11(2), 71-87. [Context Link]

Section Description


Mission Statement:Professional Case Management is a peer-reviewed, progressive journal that crosses all case management settings. PCM uses evidenced-based articles to foster the exchange of ideas, elevate the standard of practice, and improve the quality of patient care.