N684 Module 1 assignment: case management roles paper, a full sample

Four Case Managers, One Ironworker: Standards and Roles of Nurse Case Management Across the Continuum

Student Name

Master of Science in Nursing Program, Aspen University

N684: Case Management and Home Health Nursing

Instructor Name

Month Day, Year

Four Case Managers, One Ironworker: Standards and Roles of Nurse Case Management Across the Continuum

Case management is practiced in hospitals, rehabilitation facilities, insurance companies, employers, clinics and patients' homes, and in each setting the nurse case manager's title may be the same while the job differs. A patient moving through the system may meet several case managers in a few weeks, each working for a different organization and answering to different goals. This paper follows a composite patient, a 44-year-old ironworker who suffered a crush injury to his right foot on a construction site, through four case managers. It describes the functions that define case management in every setting, how each role applies them, where their goals conflict, and what the evidence says about case management's effects.

What Case Managers Do

National studies of case managers' work have identified a common set of activities across settings and disciplines: assessing the client's needs, planning care, facilitating and coordinating services, advocating for the client, monitoring progress, evaluating outcomes, and managing transitions and resources, including utilization review and benefits (Tahan & Campagna, 2010). Those studies also found that the emphasis differs by setting. Hospital case managers spend more time on utilization review and discharge planning, payer-based case managers on benefits and cost, and community case managers on psychosocial support and coordination of services over time. Professional standards of practice add expectations common to all: client-centered care, informed consent for case management services, ethical practice, and documentation that shows how the plan is developed and evaluated.

The Hospital Case Manager

The ironworker, called Luis here, underwent surgery to repair fractures and debride tissue and spent six days in a trauma hospital. The hospital's nurse case manager reviewed his stay each day against admission criteria, communicated with the workers' compensation insurer for authorization, and began discharge planning on the second day. The case manager's assessment found that Luis lived in a second-floor apartment with his wife and two children, could not bear weight on the injured foot, and was anxious about his job and income. The discharge plan was transfer to an inpatient rehabilitation facility for intensive therapy, which required authorization and a bed. The hospital case manager's goals were safe discharge at the right time and a stay that met medical necessity.

The Rehabilitation Case Manager

At the rehabilitation facility, a second nurse case manager coordinated the interdisciplinary team, led weekly conferences with physical and occupational therapists, the physiatrist and Luis's family, and tracked progress against functional goals. This case manager's focus was the transition home: arranging a wheelchair and later a walker, a shower chair, outpatient therapy and a visit to assess the stairs. The rehabilitation case manager also advocated when the insurer questioned the length of stay, submitting documentation of functional gains to justify six additional days.

The Insurer's Case Manager

The workers' compensation insurer assigned a field nurse case manager, who met Luis at the rehabilitation facility and later at home and at medical appointments. This role combines care coordination with the insurer's interests: authorizing treatment, ensuring that care follows evidence-based guidelines, and moving toward return to work and case closure. The field case manager helped Luis understand his benefits, arranged a second opinion when a surgeon recommended a further procedure, and communicated his restrictions to the employer. The dual obligation, to the client and to the payer, is a recognized ethical tension in insurer-based case management, and professional standards require that the case manager disclose the role and act with the client's interests in view.

The Employer's Return-to-Work Coordinator

Luis's employer, a large contractor, had an occupational health nurse who coordinated return to work. After twelve weeks, the nurse arranged a modified duty assignment as a safety observer, allowing Luis to return at his full wage while his foot continued to heal. The coordinator's goals were a safe, timely return, reduced lost workdays and retaining an experienced worker.

The occupational health nurse's work depended on information from the others. Without the restrictions documented by the field case manager and the treating surgeon, the employer could not design a safe modified role; without the employer's offer, the insurer's case manager would have had no return-to-work plan to support. The role is the least clinical of the four but the one most directly tied to the outcome Luis cared about most, keeping his job.

Where Roles Overlap and Conflict

Four case managers served one patient, and at times their efforts overlapped or conflicted. Both the hospital and rehabilitation case managers negotiated with the insurer for days, while the insurer's case manager pressed for shorter stays. The rehabilitation and field case managers each arranged equipment, and Luis received two shower chairs. No one owned the whole plan, and Luis later said that he never knew whom to call. Transitions are where these roles meet, and a shared care plan, a named lead case manager at each stage and a direct handoff between case managers, rather than through documents alone, could have reduced duplication and confusion.

What the Evidence Shows

Evidence on case management depends on the setting and target. A systematic review of ten randomized trials of case management for people with chronic illnesses, most focused on transitional care, found that case management greatly reduced readmissions and emergency department visits, although the included studies tended to report positive results (Joo & Liu, 2017). For work injury, the picture is less encouraging. A Cochrane review of 14 studies with 12,568 workers found no benefit of return-to-work coordination programs on time to return to work, sickness absence or the proportion at work at follow-up, compared with usual practice (Vogel et al., 2017). That finding suggests that coordination alone is not enough; what may matter is whether the employer offers modified duty and whether medical care addresses the barriers to return, as it did for Luis.

Conclusion

Following one injured worker through four case managers shows that case management shares a core of assessment, planning, coordination, advocacy and evaluation across settings, while each role's emphasis follows the goals of the organization it serves. The overlap and conflict among those roles are most visible at transitions, and a named lead with direct handoffs can reduce them. Evidence supports case management in chronic illness transitions but not coordination alone in return to work, a reminder that the case manager's value lies in solving the patient's actual barriers rather than in adding another contact.

References

Joo, J. Y., & Liu, M. F. (2017). Case management effectiveness in reducing hospital use: A systematic review. International Nursing Review, 64(2), 296-308. https://doi.org/10.1111/inr.12335

Tahan, H. A., & Campagna, V. (2010). Case management roles and functions across various settings and professional disciplines. Professional Case Management, 15(5), 245-277. https://doi.org/10.1097/NCM.0b013e3181e94452

Vogel, N., Schandelmaier, S., Zumbrunn, T., Ebrahim, S., de Boer, W. E. L., Busse, J. W., & Kunz, R. (2017). Return-to-work coordination programmes for improving return to work in workers on sick leave. Cochrane Database of Systematic Reviews, 2017(3), Article CD011618. https://doi.org/10.1002/14651858.CD011618.pub2