What is a care manager?

A care manager is a professional who plays a critical role in coordinating and managing patient care, particularly for individuals with chronic or complex health conditions. While many people assume care managers are solely nurses, they can come from a variety of healthcare backgrounds, including nurse practitioners, physician assistants, clinical nurse specialists, health coaches, and certified nurse-midwives. The title “care manager” is more about the responsibilities of the role rather than the specific level of medical training. Care managers are essential to improving health outcomes, especially in practices focused on chronic care management (CCM) and patient-centered care.

What Does a Care Manager Do?

Care managers are responsible for overseeing and coordinating a patient’s care plan, ensuring that all aspects of their health and well-being are addressed. Their duties range from assessing patient needs to connecting them with resources and monitoring their progress. Here’s a closer look at their key responsibilities:

1. Assess Patient Needs to Develop a Care Plan

While physicians focus on diagnosing and treating medical conditions, care managers take a holistic approach to patient care. They evaluate a patient’s overall situation, including their social, economic, and environmental circumstances, to create a comprehensive care plan. For example, a care manager might assess:

A patient’s access to transportation for medical appointments.
Their ability to afford and obtain medications.
Barriers to following through with treatment, such as lack of social support or financial constraints.

By addressing these factors, care managers help ensure that patients can adhere to their treatment plans, which is critical for improving health outcomes.

2. Monitor Treatment and Care

Care managers regularly check in with patients to monitor their progress and address any challenges they may be facing. These interactions often involve:

Educating patients about their conditions and treatments.
Reviewing medications and symptoms to ensure they are being managed effectively.
Conducting health assessments to track improvements or identify new concerns.
Setting personalized care goals and helping patients stay on track.
Answering questions and providing emotional support.

Care managers must also be attentive to subtle cues that patients may not explicitly share, such as financial struggles or difficulty managing daily tasks. By identifying these issues early, they can intervene and provide additional support.

3. Build Strong Patient Relationships

Effective care management relies on building trust and rapport with patients. Research shows that positive relationships between healthcare providers and patients lead to better health outcomes. Care managers act as partners in care, empowering patients to take an active role in their treatment. This approach fosters a sense of collaboration and mutual respect, which is essential for long-term success.

4. Connect Patients with Necessary Support

Social determinants of health (SDOH)—such as income, housing, education, and access to healthy food—play a significant role in a patient’s ability to manage their health. Care managers are trained to identify these factors and connect patients with community resources, such as:

Food banks for patients experiencing food insecurity.
Transportation services for those who struggle to get to appointments.
Support groups or counseling services for emotional and mental health needs.
Financial assistance programs for medication or medical supplies.

By addressing SDOH, care managers help remove barriers to care and improve the likelihood of successful treatment outcomes.

5. Collaborate with Care Providers

Care managers often work closely with physicians, nurses, and other healthcare providers to ensure seamless care coordination. They may be employed directly by a practice or work as external partners. In either case, effective communication and collaboration are key. For example, a care manager might:

Share updates on a patient’s progress or challenges with their primary care provider.
Coordinate changes to a patient’s care plan, such as adjusting medications or scheduling additional tests.
Assist with administrative tasks, such as updating patient records or managing insurance-related issues.

6. Perform Administrative Duties

Like many healthcare roles, care managers handle a variety of administrative tasks to ensure patient care is well-documented and compliant with regulations. These duties include:

Charting patient interactions and updating care plans.
Managing billing codes, such as CPT codes for chronic care management (e.g., 99490 for 20 minutes of non-face-to-face care per month).
Ensuring accurate documentation to support insurance claims and legal requirements.

Care managers often use specialized software to streamline these tasks and maintain clear, organized records.

The Role of a Care Manager in Chronic Care Management (CCM)

Chronic Care Management (CCM) is a Medicare program designed to support patients with two or more chronic conditions. Care managers are central to CCM, as they provide the ongoing, non-face-to-face care that these patients need. Key aspects of their role in CCM include:

Billing and Reimbursement: Care managers can bill for their services using CPT codes like 99490 (for 20 minutes of care per month) and 99439 (for additional 20-minute increments beyond the initial 20 minutes).
Patient Engagement: They regularly check in with patients to monitor their conditions, address concerns, and provide education.
Care Coordination: They work with providers to ensure that all aspects of a patient’s care are aligned and effective.

For example, at Compass CCM, we employ a Nurses-First staffing model, where our nurses and clinicians serve as care managers for CCM patients. Using advanced software, they coordinate communication between providers and patients, ensuring that care is consistent, comprehensive, and patient-centered.

Why Care Managers Are Essential

Care managers bridge the gap between medical treatment and real-world challenges, ensuring that patients receive the support they need to manage their health effectively. Their work is particularly valuable in:

Improving Patient Retention: By building strong relationships and addressing barriers to care, care managers help keep patients engaged in their treatment.
Enhancing Health Outcomes: Their holistic approach leads to better management of chronic conditions and overall well-being.
Supporting Providers: Care managers alleviate some of the administrative burden on physicians, allowing them to focus on clinical care.

Key Takeaways

Care managers are vital to modern healthcare, especially in programs like Chronic Care Management. They assess patient needs, monitor treatment progress, build relationships, connect patients with resources, and collaborate with providers to deliver comprehensive care. By addressing both medical and social determinants of health, care managers play a crucial role in improving patient outcomes and supporting the success of healthcare practices. If you’re looking to enhance your practice’s care management capabilities, partnering with a service like Compass CCM can provide the expertise and tools needed to optimize patient care and streamline operations.