Nurse care managers can improve patient outcomes

People who’ve had a recent surgery or live with a chronic condition are often surprised to get a call from a nurse care manager (or case manager) from their health plan. A common reaction is, "Who is this person, and why are they calling me?"

As Colleen Morley-Grabowski, DNP, RN, CMM, writes for the Case Management Society of America’s Blog, “By focusing on patient-centered care, case managers ensure that each patient’s needs, preferences, and goals guide their healthcare journey. Case managers bridge communications gaps, resolve barriers to care, and advocate for their patients.”

In particular, nurse care managers working for a health plan are in a unique position to understand a patient’s benefits and coverage and to use that knowledge to help members access care. They’re also resource consultants who have a full understanding of the physical, mental, emotional, and social supports available and often help members take better advantage of these options.

What does a nurse care manager do for members?

• Patient advocacy: Says Morley-Grabowski, “Case managers advocate for their patients, ensuring their voices are heard and their care is personalized. We work to ensure that patients can access the services they need, no matter their challenges.”
• Health education: Nurse care managers help patients understand their health by explaining conditions and treatment options. They can also offer self-care tips. This empowers members to take charge of their health.
• Care coordination: Nurse care managers help organize and manage a patient’s healthcare activities. This includes working with the patient and providers to ensure everything runs smoothly. They may assist with scheduling appointments, managing medications, and, with the member’s permission, involve family or significant others assisting members—keeping everyone informed.
• Chronic disease management: For those with chronic conditions like diabetes, asthma, or hypertension, nurse care managers offer ongoing support. They monitor symptoms, adjust treatment plans, and provide lifestyle advice.
• Support for complex needs: They connect patients with the resources and services they need, including social support and community resources—like food, housing, rides to medical appointments, and more. This is one of the ways they can really expand the services available to a member.
• Improving self-management: Nurse care managers may teach patients how to manage their health independently, from understanding medication schedules to recognizing symptoms and knowing when to seek help.

Meg Flynn, RN, Manager of Coordinated Care at Mass General Brigham Health Plan, says, “A good nurse care manager believes change is a process and respects a member’s readiness and ability to change behavior.”

When hiring and training nurses on her staff, she looks for candidates who exhibit the following skills and attributes.

• Interpersonal skills: Connecting with patients, families, and healthcare providers is crucial. Effective communication, empathy, and relationship-building are key.
• Clinical competence: Strong clinical knowledge helps nurse care managers make informed decisions and earn respect.
• Leadership: They need to inspire and motivate their patients and the caregiving team.
• Decision-making and problem-solving: Critical thinking and quick analysis are essential.
• Time management: Balancing multiple roles requires excellent time management skills.
• Adaptability: The healthcare environment is constantly evolving, so adaptability is important.
• Emotional resilience: Supporting patients with complex needs requires emotional strength and resilience.

By building trusting relationships and empowering patients, nurse care managers significantly enhance the patient experience and contribute to better health outcomes. Their dedication ensures that patients receive the holistic care they need to navigate their health journeys successfully.

If you are a member of Mass General Brigham Health Plan and feel like you could benefit from the services of a nurse care manager, please email HealthPlanCareManagement@mgb.org.