At a time when hiring RN case managers and social workers is a challenge, it may be time to look at hiring case management extenders.
They may be called case management assistants, referral coordinators or case management associates, but the job is the same. They handle clerical work and other jobs that don’t require a license, freeing up the case managers to concentrate on tasks that need their expertise.
“If hospitals want to decrease the length of stay and expedite discharges, extenders are vital,” says Christine Babina, RN, BSN, a case management consultant in Oxford, CT. As a case management director at a large hospital, Babina helped make an existing case management extender program more efficient and effective by implementing discharge planning software. “We amended the program because wanted the nurse case managers to be able to concentrate on complex situations that need a nurse’s scope of knowledge rather than spending their time and expertise doing paperwork, faxing, and filing,” she says.
Justifying clerical support for case managers to the executive team is often a difficult task, but it can help relieve an overworked staff, says BK Kizziar, RN-BC, CCM, owner of BK & Associates, a Southlake, TX, case management consulting firm.
Case managers are doing everything from copying charts to filing, faxing, phoning, stapling, and writing reports, she adds. “These all take a lot of time but are not part of the actual case management process. As long as case managers are doing clerical jobs and other busywork that keeps them away from the floor and interacting with patients and physicians, the case management department is not going to have maximum success,” she says.
Case management extenders are become more prevalent, but the vast majority of hospitals do not have them, says Beverly Cunningham, RN, MS, consultant and partner at Dallas-based Case Management Concepts.
If you have case management positions that you can’t fill, consider taking a position and turning it into a case management extender position, she suggests.
“An extender can’t replace everything case managers and social workers do, but they can support them so they can do the things they do best every day,” Cunningham says.
Case management extenders can be trained to help with basic discharge planning tasks, such as giving patients the letter stating they have a choice of post-acute providers. They can do a variety of tasks such as ordering durable medical equipment or running errands for the case managers, particularly if the case managers cover more than one unit, Cunningham says.
Case management extenders should work as a team with case managers and assist them in orchestrating patients’ care and the discharge process, Babina says. “Their work can expedite the discharge process and give the nurse case managers the time for other duties,” she says.
In her department, each extender worked with case managers on approximately four units and was responsible for about 60 to 80 patients. They were responsible for finding out if patients and families had a preference of a post-acute provider and/or helping them choose one.
“Once a patient was ready for discharge, the case manager informed the case management extender who uses the department’s discharge planning software to gather information on the patient and transmit it to the providers the patient has chosen,” Babina says.
The case management extenders collaborated with nursing, case management, social work, physical therapy, and occupational therapy to meet patient needs, she says. They worked with nursing to make sure that the discharge planning paperwork, including physician orders, were complete and that the transcription was done in a timely manner, she says.
Case management extenders don’t necessarily need a college degree but some experience in a health care setting is helpful, Babina says. “It helps if they are familiar with medical language,” she adds.
Extenders should be able to work under stress in a fast-paced environment. They should be computer-literate, articulate, and make a good impression, Babina says.
“We found case management extenders to be extremely helpful. They established a relationship with the case managers to which they were assigned and with the providers and resources in the community. As they were discharge-savvy, they became the right hand of the department and made a good workflow even better,” she says.
