Very few people are aware of who RN case managers are, much less what they do. The Dean Health System has case managers both in the clinic and at the Dean Health Plan. Here is Miriam Webster's definition of a case manager: "a person (as a social worker or nurse) who assists in the planning, coordination, monitoring, and evaluation of medical services for a patient with an emphasis on quality of care, continuity of services, and cost-effectiveness".
Renee Probst is a fellow colleague of mine here at the Dean Health Plan. Renee is an RN case manager working mainly with patients before and after they get a stem cell transplant. Not only are the patients initially scared and anxious with their cancer diagnosis, but they are confused with the insurance coverage and what is involved in the process of getting transplant services "Out of Network" at places such as the UW or Froedtert. I occasionally listen to Renee on the phone as she provides compassion, encouragement, and empathy to patients as well as for instructions for how to navigate the complex health systems.
Renee stays current with the latest treatments for her patients who have blood cancers such as leukemia, lymphoma and multiple myeloma. She is constantly learning about new clinical trials and what is changing with the standards of care. She attends conferences, participates in Webinars and reaches out to hospitals to find out more information about treatment options.
She is the liaison as well between the patient's oncologist, the transplant teams at UW (out of network places) and the Customer Care department here at the Dean Health Plan. She makes sure all involved are working together to assist the patient rather than each working in their own "silo", unaware of what the other is doing.
In a recent case, a patient was seemingly caught in the middle with providers not submitting prior authorizations, facilities billing the patient and claims getting denied (meaning the onus would be on the patient). Renee took the time to assess the situation, bringing the involved parties together to get a resolution. This benefitted the patient who was so ill and actively going through a tough treatment. This is just one example of many on how Renee is an advocate for her patients.
Renee is an invaluable member of the Dean Health Plan care management team. Because of Renee's diligence and great attention to detail, the member's transition through the transplant process is much smoother. As Renee tells her patients, "you just need to focus on getting better, I will help manage the rest".