Meet Healthcare Case Manager Lori R. Young – Treating Each Patient Like a Work of Art

Monday, March 4th, 2013
This post was written by Cheryl Miller

This month we provide an inside look at a healthcare case manager, the choices she made on the road to success, and the challenges ahead.

Lori R. Young, RN, CCM, Case Manager Mid-America, North Flex Medical Team

HIN: Tell us a little about yourself and your credentials.

(Lori R. Young:) I’ve been a nurse for more than 25 years. I have a current RN license in both Georgia and Florida, and recently obtained my certification in case management, which I enjoy very much. When I began with Aetna about seven years ago, I spent my first four years in disease management. I was one of six core nurses chosen for a large employer customer team. Only six nurses out of the entire disease management team were chosen, so that was quite an honor in itself. I was also the nurse chosen to meet Ron Williams, our CEO at the time. They selected one nurse for him to talk with and see how we do things, and what our workflow was. Meeting Ron and having that experience was a wonderful experience.

What was your first job out of college and how did you get into case management?

I have actually been a nurse since I was 15 years old. I started in South Florida as a candy striper in a geriatric home there. I would write letters for patients, hold their hands while they were having their blood pressure done. That is how I began in nursing, solely on a volunteer basis.

Seeing the difference that caring and respect made had a big impact on my life. I’m a very positive person. I’ve been an artist for the past 25 years, and that does play into this. Each piece I do is unique and it’s how I view my patients and my members.

What kind of art do you do?

I use multimedia. I am a gourd artist; gourds are natural products and I do high-speed carving, including a seasonal Santa Claus line. Three or four years ago I did a show for HGTV, I was one of six artists featured, and it was the greatest time. I also create a line of jewelry with my mother; she is in Florida, and we make bracelets for the battered women’s facility there. My mom presents them to people who have nothing. And I also make glass; I turn it into what appears to be stained glass. I created an entire line of these and gave them as gifts to a group of nurses I worked with; each piece had their names carved into the glass.

That’s in my midnight hour. It’s so relaxing to do nursing and case management all day long on a full-time basis and have that time of relief. And I think it actually makes me zero in even further the next day when I go to work.

Has there been a defining moment in your career, perhaps when you knew you were on the right road?

There have been so many it’s hard to pick just one. I assisted a family with two children; I was assigned to be the father’s case manager after he had an acute MI. It was the scariest night of this family’s life, and the mom said it was a night that changed their life around. She wrote a letter to Aetna and dedicated a song to me, She’s an Angel, by Alabama.

I still get tears in my eyes when I feel like my patients are holding my hand over the phone or they bring me into their personal lives and tell me how their grandchildren or their elderly parents are. I believe that is such an important part in what we do.

In brief, can you describe your organization?

I am extremely proud to work for Aetna. It’s a company that has helped build and shape America for over the past 160 years. I respect our leadership in (Aetna CEO Mark) Mr. Bertolini and those who work with him. It was about 1850 or 1853 when Mount Aetna erupted, an 11,000-foot volcano in Sicily that led to the naming of Aetna. To this day I still feel such pride and passion in working with them because I feel they shape America on behalf of our members, the communities they serve, and their endless efforts to give. They’re the first ones there when a tragedy strikes. I just can’t say enough for my company, for our company and its leadership.

What are two or three important concepts or rules that you follow in case management?

Privacy is one of the most important concepts, whether you’re in an elevator or whether you are standing with your friend on the corner and talking. We have a very large population of baby boomers and late baby boomers and you just never know who is standing next to you in an office or elsewhere.

People are so unique onto themselves, just like my art pieces – their expectations, their level of knowledge of procedures, techniques, doctors, personalities, the healthcare system itself. There’s so many complexities that each and every person has to absorb; I think proper assessment, and respecting privacy is very important.

I also believe that collaboration between our departments, between our managers, and our higher management is important; that we talk to each other on behalf of our efforts towards each member of patient. What do they need? We can’t be afraid to talk to each other or that it’s going to take too much time.

Lastly, most of us are telephonic, and it is important that our members or my patient knows my sincerity, and the smile on my face. I want to treat every single person like they’re the 8:30 call of the day. I want them to feel that. I don’t want them to think I’m too busy to hear something very important, or that they’re just going to throw something by me and see if anybody cares, and if they get a response. I really do want to be that person that hears them.

What is the single most successful thing your organization is doing now?

With the changes coming in healthcare, there’s a great deal of fear among people: fear of the unknown, fear of whether their children, as they get older, will have insurance. Do they even know what a socialized system is? Do they know whether or not this is going to become the system? Aetna wants to be the forerunner. They want to get it right. And they want to get the information correct and get it out to the people as easily and thoroughly as they possibly can. Aetna Navigator is a tool that our members have access to with private ID and password. It’s a very secure site that each year is becoming more and more user friendly. And reaching out on a community level is very important. I believe there is a great need for Aetna to come to the neighborhoods.

Do you see a trend or a path that you have to lock onto for 2013

The trend that I’m seeing is providing an increased knowledge base to our communities and our existing members. Helping them to understand. It’s difficult for most of us that have been in healthcare for 25 and 30 years; it is quite complex. And to do this not only in a multilingual sense — we have a language line that is just sensational – but to provide people with the most accurate, easy to understand information. I’m going to use ‘accurate’ as the first word, because they hear so much from so many sources, and so many of them depend just on the television. My goal would be for Aetna to provide these people with a better understanding of where we’re headed.

What is the most satisfying thing about being a case manager?

Being a case manager is multifaceted. It is being able to be the patient’s advocate and assist them and their families with their healthcare benefits, and help them utilize their benefits to the maximum degree.

And the most important thing is, again, to let them hear my voice, to let them know how much I care. This is not just a business transaction. This is their life, their family’s life, and I really care that we do this right.

What is the greatest challenge of case management and how are you working to overcome this challenge?

One of our greatest challenges is patient load. We are a very busy team and no matter how busy, we still assist other teams when needed. No matter how busy I am, when I speak with a person I don’t look at a clock. Our case managers’ time management skills are sensational for everything from technical problems (the biggest thing that can slow us down) to the patient who needs to talk for 90 minutes versus the patient who only needs five minutes. Time management is a great skill that case managers must possess. And, the case manager must maintain a balance: after you finish with that 90 minute member, the next person should feel like they’re the first one of your day. And that’s a fine balance.

What is the single most effective workflow process, tool or form case managers are using today?

The most important tool we have is collaboration. It is the greatest tool that I know of, to collaborate with my peers, medical directors, supervisors, and it all requires excellent time management. If you have spent 10 minutes, or you have clicked three times to reach what you’re after and you’re still not there, reach out. Manage your time. We all get caught up in it sometimes. We want to be successful in our search of that unique thing, but as a team, it’s best to be time efficient and reach out to your peers.

We also have a Wiki, which identifies a complete workflow, and we have our central sites that we go to. Aetna has provided unlimited resources – (PS2) performance tools if we need them – if you have a very difficult case and want to look at that discharge plan and get your flow down just a little bit better, it’s available. It’s there for us.

Finally, continuing education. We’re in a very fast-moving medical world. So what they offer us in continuing education is just phenomenal.

Where did you grow up?

I grew up in Hollywood, Florida. I started my prerequisites at Broward Community College and didn’t know anyone except a cousin in Georgia, but I had always heard Georgia was a beautiful place.

In high school I was the recipient of a junior scholarship. It was out of financial need, and it was for dental hygiene because I had six years as an oral surgical and dental assistant prior to becoming a nurse.

Even though I had received a scholarship, I stood up and I said, “Please give this to someone who is going into dental hygiene, I’ve just decided I’m going to go into nursing and become a nurse.” I gave up the scholarship to someone who could definitely go forth and use it for their dental hygiene career.

Are you married? Do you have children?

I do not have children, but I rented about a thousand of them. I was in pediatrics for 12 years. It was an absolute joy. I did not have children by choice. I am married to my absolutely most adorable best friend.

What is your favorite hobby?

It is my art and being outside. I love to create unique pieces. And Mother Nature is one of my greatest past times. We live on a creek and I just love the hummingbird migration time. I feed the birds, the rabbits, and the deer; we had baby warblers, cardinals and wrens this year. I love watching them making their homes and nest. And then they have the babies right there.

Is there a book you recently read or a movie you saw that you would recommend?

Yes, l very much like the David Baldacci series. I just loved the Camel Club (a trilogy). And I was so excited about the new Men in Black movie that came out. But that’s not the one I would recommend. I would recommend Avatar, for its creativity. And I’m an old movie buff. Gunsmoke is one of my favorites.

Any additional comments?

I’m in a place in my career of combining business and medicine. I guess that dreams do come true. I worked very, very hard to get here and I am honored to be with a company like Aetna.

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