Case manager in the private sector
Working as a case manager in the private sector allows nurses to act patient advocate and learn new skills.
If you are involved in an accident, or sustain a work-related injury, undoubtedly you would want some financial compensation. But if the injury means you cannot return to work, you may have other issues to deal with besides money worries. So with the personal injury lawyers in one corner, and the insurance companies in the other, who is there to fight for your needs as the injured person?
Step forward nurse Liz Haunch, director and medical case manager for the Independent Case Management Consultancy Limited (ICMC). ‘We don’t take sides and treat every case on its own merits,’ she says. ‘We always adopt a holistic viewpoint because the social and psychological aspects of returning to work are just as important – it is not just about the injury.
‘I had a client who had two fractured ankles and obviously couldn’t get out to work. He was terrified of losing his flat because he couldn’t pay the rent and the fear of becoming homeless was putting a great strain on his mental health. We had to make sure we helped him deal with the psychological issues so that he could concentrate on getting better physically.’
A case manager’s role involves using specialist skills and knowledge to collaborate with clients by assessing, facilitating, planning and advocating health and social needs on an individual basis. ‘We look at the situation and see what the client needs and what we can do to help. From someone who has suffered whiplash in a road traffic accident to a client with more complex needs, we take on cases at all levels,’ Liz explains.
‘We are the point of contact for the injured person and act as their advocate to help them take control of what can be a very confusing situation. We liaise with doctors, physios and OT’s to make the care less fragmented and make sure healthcare progresses quickly so the client can get back to work. We also educate clients and keep them informed of what is happening.’
Having worked in areas as diverse as orthopaedics, plastics and occupational health, Liz has been involved in case management for the last four years and set up ICMC with two colleagues a year ago. As an independent company they take referrals from, and provide services to, personal injury lawyers, employers and the insurance industry, and one of the most important services they provide is that of client rehabilitation.
‘We live in a compensation culture so rehabilitation within personal injury cases is huge. The lawyers want to get the most amount of money for their client, and the insurance companies want to minimise their outgoings, but it is important to remember that there is a human being at the centre and what we want is the best possible outcome for them,’ she stresses.
The introduction of the new clinical role of community matron, as part of The NHS Improvement Plan (2004), has also put rehabilitation at the top of the government’s agenda. Central to the government’s policy for the management of people with long term conditions, community matrons use case management techniques to ensure all the health and social care needs of these patients are met.
‘The role of the case manager and the community matron are very similar,’ Liz admits. ‘We both deal with the complex needs of clients and act as an advocate so that the person who needs to can access the care and information they need – we deal with the whole package. We can also share knowledge – community matrons are clinical experts and we are more knowledgeable about the commercial side of things.’
Because she regularly deals with lawyers, insurance companies and employers, the commercial aspect of Liz’s job is very important. ‘You have to be aware of the business aspect and have good business sense because there is a lot of money involved in personal injury claims. But the problem is that some companies are in it just for the money and are not client-focused. We set up ICMC because we wanted to provide good quality, patient centred services.’
Standards of best practice for case management have been set by the Case Management Society UK (CMSUK), and the Association of Personal Injury Lawyers (APIL) and the Association of British Insurers (ABI) also have guidelines on the best practice guide on rehabilitation and critical illness cover.
When Liz first started working in case management in 2002 there were not many companies around, but she has seen a rapid growth in the number of case management companies over the years. ‘It is a great area for nurses to get into because you can really utilise all your skills, especially your communication and problem solving skills. It is also really rewarding to help people in ways that are not traditionally associated with nursing.
‘We work office hours so the hours are good and the pay isn’t bad either. Ideally I would like to see a case management module incorporated into nurse training and for the role of the case manager to become as recognised as that of the community matron.’
How do I become….a medical case manager?
This could be for you if: you are interested in rehabilitation and acting as a patient advocate with employers, lawyers and insurance companies.
You need to be good at: problem solving, communication skills, team playing, and have good business sense
You need to have: a medical/nursing background, preferably with some occupational health or health and safety experience.
You don’t need to have: previous direct case management experience
Other similar jobs you could consider: occupational health nurse or community matron.
Where to find more information:
Independent Case Management Consultancy: www.ICMC.org.uk.
Case Management Society UK: www.cmsuk.org.
To learn more about the role of community matron visit DH website: www.doh.gov.uk