Thoughts from Jo Carter, RN, BSN, CCM, Paradigm Outcomes’ vice president of network services.

If asked to write a job description for a Paradigm Outcomes network manager focused on catastrophic injury, one would be challenged to explain everything needed to be successful in the position. Individuals in this role – which is complex and unique – are focused on what’s best for the patient and what will result in the best possible health outcome.

It’s a role that demands a seasoned nurse and case manager who is also able to play the injury expert, educator, cheerleader, advocate and giver of hope day in and day out.

Every catastrophically injured person that Paradigm supports works with a network manager, an onsite nurse who leads all efforts to coordinate care and help navigate the maze of care. In these challenging cases, the injury is not the only thing that is catastrophic – all spheres of the patient’s life are affected and require a specialized approach to address the many biopsychosocial components.

“At Paradigm, we practice a dynamic process called Systematic Care Management^SM. This involves pulling together a team of specialists with specific expertise to serve each patient’s individualized needs,” said Jo Carter, RN, BSN, CCM, Paradigm’s vice-president of network services. “Every case is assigned to a network manager who works collaboratively with a director of clinical services and Paradigm medical director to create a coordinated care plan and problem-solve as the patient progresses through treatment and integration back into the home environment.”

To give an example of the catastrophic injury nurse’s demanding role, we can look at a case of a spinal cord injured patient who, after initial emergency treatment and critical care, is in need of everything from recovery in-hospital to rehabilitation services and preparing the home for wheelchair access. This coordination of care can be extremely challenging and requires injury-specific knowledge, empathy and clear communication with the injured person, family, care management team and payor sources.

The network manager often has to explain factors likely not understood by all parties, as well as provide “anticipatory guidance” –educating everyone about how real life situations may play out. For example, integrating someone back into the home environment requires the network manager to think about a number of challenges and risk factors, and how they will deal with the possible scenarios, from a medical perspective (Are qualified care providers nearby?), support systems needed (Do they have wheelchair access throughout the house?), psychological impact to the patient and capacity of the caregivers (Is the social network stable?).

At a glance, a Paradigm network manager focused on catastrophic injury must be:

• An expert communicator and negotiator
• Extremely detail-oriented and able to handle minute details while overseeing the big picture of coordinated care
• Positive and strong, able to educate and empower patients and families toward the best possible health outcome
• Resourceful, creative and curious, with a tendency to enjoy problem-solving and finding solutions where others may not see them
• Expert in their area of nursing with years logged in the ER and other complex care environments
• Ability to remain calm under extreme pressure and multiple competing priorities
• Deeply rooted in the knowledge of insurance and workers’ compensation processes, legal implications and jurisdictional requirements
• Resolved in their commitment to putting the patient first, before the process
• Always effectively problem-solving

To learn more about Paradigm’s network managers and Systematic Care Management^SM methodology, visit our website or follow us on Facebook, Twitter, and LinkedIn.