My Specialty

Care Management, Jonathan Lee, Inland Empire Health Plan

Providing resources, guidance and care coordination telephonically

By Keith Carlson, RN, BSN, CPC, NC-BCSeptember 7, 2020

3 min read

Jonathan Lee, RN
Care Manager, Cal-Medi Connect
Inland Empire Health Plan (IEHP)

Please share with us the arc of your nursing career.

Nursing is my second career. I was a graphic designer for a few years, but several things brought me back to school to study nursing. I have many family members in the medical field, and it was on my mind even when I went into the arts. Since I gravitated towards psych nursing and behavioral health during school, I went directly into an inpatient psych unit after I graduated in 2013. I was working in one until I took this position at IEHP about a year ago.

What’s a typical day like for you?

Our work as care managers is strictly telephonic, so I’m on the phone a lot with our members. (We don’t call them “patients” or “clients.”)

IEHP is the largest not-for-profit health plan in the country, with a staff of more than 2,000 and more than 1.2 million members in San Bernardino and Riverside counties. Our members range from individuals with multiple complex comorbidities to those with fewer medical issues who still want to avail themselves of the many resources IEHP offers.

My typical work day involves focusing on triaging members to see whose needs are most pressing and should be addressed first, with the top priority being those newly discharged from the hospital. The post-hospitalization process can be stressful for any member, and I’m there to provide information, resources, guidance and care coordination.

Some members use IEHP services in an episodic way, but we still keep in touch as needed and make sure they’re healthy and well-resourced.

What are some common health concerns for your members?

The most common are CHF [congestive heart failure], uncontrolled diabetes, complicated COPD [chronic obstructive pulmonary disease], various cancers and chronic pain. There’s no 100 percent typical patient, but those are some of the comorbidities we see most often.

Our members also present with a significant number of mental health and substance use disorders. Some members’ mental health can be quite fragile, especially when they carry the weight of managing many conditions, symptoms and polypharmacy. Some may have a significant psychiatric history or mental health diagnoses.

As a nurse care manager, I can of course discuss these issues with them as needed, but we also have an amazing behavioral health department that offers complete multidisciplinary coordination. We offer many resources, so our members are covered for whatever they need.

Describe some of the challenges of your job.

Since our cohort is so varied and can present with such different needs, I have to be versatile and adaptable at all times. Since we don’t use video platforms, a major challenge in creating rapport is the loss of the nonverbal communication that we humans rely on so much.

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That said, IEHP does have several buildings where members can go to actually meet certain staff for specific purposes. We also have three community resource centers offering free yoga and Zumba classes, health education seminars and other classes. I never knew how much IEHP contributes to the community and how central this is to our mission.

What is the care manager-member relationship like?

We typically follow up about once a month. The level of relationship varies from member to member. Some don’t want to share much with me, while other members are happy to tell me the names of their dogs and kids, their weekly schedules and other details of their daily lives and families.

Although some members require more effort on my part to make a connection, I challenge myself to build rapport and get them to open up. IEHP is very member-centric, and the only way to get to what’s really bothering them is to carefully build trust over time.

Do members sometimes refuse to connect with you?

Of course. It’s 100 percent voluntary, so if a member doesn’t want our services or any follow-up, we honor their request and let them be. Also, if there’s a diagnosis like cancer that they simply don’t want to discuss, we don’t push them on it.

Can you give an example of the kinds of things you do for members?

After a member is discharged from the hospital, it’s a big challenge to know how or where to begin. Also, when an unexpected diagnosis appears out of nowhere, it drops a huge weight on someone’s shoulders.

Many members live alone and don’t necessarily have support in accessing the appropriate resources. That’s where IEHP comes in and where we can do really great work.

Whenever a member is in need, I can connect them with caregiving services, referrals, specialist appointments and anything else that arises. I work closely with our members to remind them of their appointments, prep them for procedures and tests, and do my best to calm their fears. I lay it all out for them so that they’re not surprised when they go to an appointment.

Do you interface with providers directly to advocate for members?

Oh, yes. We actually have a portal connected to each provider’s office, so any time a provider wants an authorization, they can upload it to our system. That’s one way of connecting and communicating in order to coordinate care. We’ll advocate if the member wants us to, and I personally reach out directly to Medi-Cal with pressing concerns.

What socioeconomic or psychosocial issues do you see most often?

Transportation is a big one, so we work with transportation companies, including public transportation, to get members to and from any medical appointment as needed. We can save our members a lot of money with this benefit.

Food insecurity comes up a lot too. IEHP is conducting a large outreach initiative right now for members at risk of running out of food. These are tough times financially for many people, so we do our best to facilitate access to food banks and food delivery, and we actively support our local food pantries.

How has COVID-19 changed the nature of your work?

The impact has been enormous. Our members are of course concerned about contracting the virus, so they often fear going to a hospital or medical office even for routine things.

We educate our members about COVID-19, including precautions and symptoms, and we serve as guides to help them understand when they absolutely must go to the hospital. Also, many people are choosing to put off important preventive measures, so we encourage them to not forget their basic wellness and healthcare needs.

Do members talk about isolation?

They definitely talk about it, as it can be a big issue for people of any age, especially during this pandemic. We work closely with our behavioral health department to provide reassurance and connect members with therapists and other professionals as needed.

What do you love about your work?

The relationships with our members. I have many members who are excited to talk to me. They love our monthly calls. We talk mostly about health, but when we have a nice rapport, they also open up about their families, personal lives and pets. This is a real unexpected benefit to this job.

Seeing members progress and get better and being able to guide them through what can be the hardest parts of their lives is also very gratifying, as is providing education and reassurance.

I also love the continuous learning aspect. We have interdisciplinary care team (ICT) meetings where we take a multidisciplinary approach to addressing members’ medical, behavioral, psychosocial, cognitive and functional issues.

I presented a case just recently. One of our directors was able to educate me on some available palliative care programs and how we could provide doctors, home health nurses, chaplains and social workers for our members in their most vulnerable states. I also love that we can pursue various certifications. I’m learning case management on the job, but the more I get into it, the more I want to pursue the third-party complex case management certificate.

What are your career goals?

I definitely want to continue my education, so I imagine I’ll get a master’s degree at some point. Even though nursing school was as hard as anything, I’ll go back some day. I’ve really valued my experience with IEHP so far, and I can see myself continuing my career here. There’s a great workplace culture. We like to say that we’re the health plan with a heart — and it’s not just because there’s a heart in our logo.

KEITH CARLSON, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has hosted the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.

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