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A Day in the Life of a Case Manager

Posted By Fran Parker, Wednesday, October 07, 2009
Updated: Thursday, June 09, 2011

Clinical case management is a core aspect of Marillac Clinic's Integrated Care model. It is provided by a full-time case manager, all of our counselors, and (to a lesser degree) by our medical and nursing providers. These services were recently described in the national periodical for case managers and in a description of Marillac Clinic's integrated care services that was presented to the Advancing Colorado's Mental Health Care initiative.

The following is a description of an actual day in the life of our full-time case manager, Sarah.

Sarah starts her Tuesday at 8:00 am at the weekly mental health providers' meeting. Her participation in the meeting is disrupted when the front desks calls her to help with a patient. Martha, a 58 year old homeless woman, has come to the Clinic, asking for an early medication refill.

By 10 am, Sarah has handled phone calls from two parents calling on behalf of adult children waiting for medications through the Medication Assistance Program (MAP). She's assisted two patients with the disability application process. The local mental health center has faxed a discharge plan for a patient who will be coming to Marillac for service, and she decides she needs to follow up for additional information.

Over the next hour and a half, Sarah gets two requests from women needing early medication refills because of travel plans. Lisa makes her request in person. Sarah is familiar with Lisa's case and provides a brief counseling intervention since her mental health provider is not available. The other early refill request is made over the phone. Sarah is familiar with Karen, who has "no-showed" for several medical appointments. The patient has been told repeatedly she needs to see a medical provider before her prescriptions will be refilled. Sarah tells both women she will need to check with the "medical team" and get back to them.

The Clinical Case Manager also answers disability related questions from another patient, reassures an asthmatic patient who calls concerned that her Advair will not arrive in time, and handles a phone call from a pharmacy provider confused about the pharmacy's new contract with Marillac Clinic. She briefs two of her colleagues, a physician assistant and a mental health provider, about a patient with auditory hallucinations. Sarah's scheduled the two providers for a joint appointment with this patient.

When a medical provider asks Sarah to "meet and greet" a patient just discharged from an inpatient substance abuse program, Sarah goes into the exam room, talks with him, and reinforces his relapse prevention plan. After 25 minutes, the two of them decide he currently has enough structure and support in an aftercare program. Sarah tells him to call her if he needs help.

At 11:40 am, Sarah finds the Medical Officer of the Day (MOD) and discusses the two early refill requests. The MOD approves Lisa's request. However, the MOD does not approve Karen's request. Instead, the MOD writes a prescription with instructions on how to taper down the patient's anti-anxiety medication. When Karen returns from her trip and keeps an appointment with a medical provider, her health status and medication needs can be reassessed.

Before she leaves for lunch, Sarah discusses financial assistance programs with a 29 year old patient who needs shoulder and eye surgery. After lunch, she fields another call from the pharmacy and faxes a voucher so the cost of medication for a homeless man will be billed to Marillac. She listens to voice mail message from a case manager at the local domestic violence shelter who's checking on the status of the agency's request for a psychiatric evaluation of an undocumented person.

There's also a message from a man who needs a psychiatric consultation about potential interactions between his psychiatric and other medications. Sarah has been working for three months to arrange a consultation with an out of town psychiatrist, due to the local shortage of psychiatrists. She makes several phone calls to arrange an appointment on a day the patient will have transportation.

Mid-afternoon finds the Clinical Case Manager getting patient updates from several colleagues, a volunteer counselor and a staff mental health provider. She reviews the records on Larry, who has two prostheses. Larry can't afford the approximately $1,000/year cost of replacement parts. She calls the prosthetics provider about arranging a payment plan.

At 3:15 pm, a medical provider asks Sarah to meet with a woman who's grieving her mother's recent death. Sarah spends nearly an hour encouraging the woman to find some balance between meeting her father's needs and her own self care.

As the day draws near to an end, Sarah talks to a medical provider about potential resources for Leonor, a woman who has a very large kidney stone. Leonor's not a citizen so she isn't eligible for most assistance programs.

She responds to another call from the pharmacy and another patient who's seeking sample medications while waiting for MAP. After receiving a second phone call from a father about his daughter's medication, Sarah checks the Medication Outlet and finds the medication has arrived. She calls the father back with the good news.

Sarah ends her day noting that it has been kind of slow!

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