It is 8AM at rush hour, and I'm grabbing my things and heading to the train. Today is a Monday, which means it will be a busy day at the office for me. Thirty minutes later, I am off the train and already running a few minutes late. However, I have to stop by Joe's coffee cart on the corner to grab a cup of joe. Finally, I've made it to work. I say a quick hello to my co-workers and begin to check my voicemails and tasks for the day.

Welcome to a day in the life of care management and coordination.

Nurse Care Managers and Coordinators - Why Are We Needed?

My name is Irina, and I am a registered nurse and a care manager for an insurance company in New York City. When I tell people that I'm an RN care manager, I often hear "What is that? Are you even a nurse?" As the Robert Wood Johnson Foundation defines it, care management is "a set of activities intended to improve patient care and reduce the need for medical services by enhancing coordination of care, eliminating duplication, and helping patients and caregivers more effectively manage health conditions"

In simpler words, I help people navigate the healthcare system, communicate with their providers, provide education, and ultimately help them stay safe and healthy in their communities. A nurse care manager is a nurse, but also much more than I listen when others often don't. I genuinely hear their concerns and do my best to help.

What Type of Patients Do Nurse Care Managers/Coordinators Help?

There are no voicemails today, and that's rare. Now, it's time to move on to my task list. First, I need to call Ms. Jones (name changed) to review medications and try to get her into a patient assistance program since she can't afford her co-payments. Second, Mr. Noor can't get through to his doctor's office to schedule an appointment and his back pain has become much worse. Third, Ms. Galavan is still waiting for her CPAP machine. It has been weeks, so I need to contact the supervisor over at UM to discover the reason behind the holdup. My other members mostly need education around diabetes management and hypertension management. Some have questions about their kidney disease, and others may need support with understanding how to use 14-day FreeStyle Libre. I have 25 tasks on my to-do list for the day, which probably means that I will make at least 30 phone calls to members and providers.

There is a call coming in. This is from one of my newest members, and I have not spoken with her yet. I usually work with older adults, but she is only 38 years old. She is crying. I listen first and then listen more. She lost her husband recently and is severely obese. She doesn't have anyone to help and feels hopeless and depressed. She tells me that she can't even get food. I let her know that I am here to support her in any way that I can. I then need to determine if her finances are stable. If so, we can arrange a grocery delivery. If not, I will need to search for community resources like Meals on Wheels if she qualifies. I also need to connect her to behavioral health services to help manage those feelings of depression. In the meantime, I will provide information for NYC WELL, a mental support resource with free counseling. This call lasted over an hour, and she stopped crying. I think that I gave her some hope.

Working with the Interdisciplinary Healthcare Team

In the afternoon, we have our rounds with the wellness team. I work closely with health coaches and sometimes co-manage members. Our wellness team is dedicated to helping members set goals and make lifestyle changes that benefit their overall health. Today's member is presented by my colleague. Mainly, the discussion focuses on the member's progress over the past few months. His A1C has improved significantly and is now down to 7.8%. He continues with his workout routine and diet. He does report side effects from metformin and admits to skipping doses at times. The nurse will need to discuss this with his endocrinologist, and hopefully, switch him to a different medication. At the end of the conference, everyone is chatting, telling jokes, and saying goodbyes until next week. Now, it's back to my task list. Where was I?

RELATED: MSN in Care Coordination Programs

I hope this gave you a glimpse of what nurses care managers do. It is not an easy job, but it is rewarding. The role takes a high level of dedication and persistence. Also, some days are easier than others. There are days where it feels like I am not helpful whatsoever and other days where I feel that I am really making an impact. The best reward is hearing "Thank you for caring and helping". My goal is always to help my members achieve optimal health and provide access to services, just as the American Case Management Association defines it.

Irina Wiley, RN, BSN
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