Case Management Authorization Coordinators
Lori N. Keller
Western Governors University
Leavitt School of Health
Stephanie Hills
March 31, 2025
, D156: Business Case Analysis for Healthcare Improvement
Healthcare Improvement Project: Introduction and Project Initiation
Organizational Problem
The healthcare company is a comprehensive case management company that provides
case management and utilization review services to adult and pediatric populations. Consistently,
the turnover remains at approximately 20%, with most resignations occurring during the first
year of employment. The employee satisfaction surveys, orientation feedback, and the
information obtained during the resignation process have shown that one of the most significant
factors is the requirement to learn the case management process as well as the authorization
process for complicated multi-step authorizations such as chemotherapy and radiation therapy
within the first 3 months of training without the ability to focus on learning essential case
management skills first.
In our 1:1 conversations with new staff, the authorization process is brought up
frequently as a hurdle and as something the staff feels they need to prioritize over patient
outreach, communication, and other case management skills. While case managers are still
learning the basics of telephonic case management, this rapid introduction to authorizations has
increased turnover and decreased satisfaction. This Healthcare Improvement Project will aim to
develop a new position for Case Management Authorization Coordinators. These CMAC nurses
will primarily own the new hire oncology case manager’s chemotherapy and radiation
authorizations for their first 3 months of training, allowing for increased understanding of basic
case management skills, increased retention, and increased employee satisfaction while ensuring
quality patient care and customer service.
, Currently, new hire Oncology Case Managers must begin working on their own
chemotherapy and radiation therapy authorizations as soon as they complete authorization
training, around weeks 5-6 of orientation. Before they complete training, the team supervisor
would need to find an existing case manager who could take ownership of their authorization
through completion. This increases frustration for case managers already working on their
authorizations and carrying a caseload of approximately 60-65 patients. Once the new hire has
completed authorization training, they are expected to begin this authorization process
independently with little support from the education team. While they have a specialty buddy
and a mentor, many authorizations come over urgent from clients or providers with treatment
due to start within 24 hours. For new hire case managers, this is when the stress hits. They are
working on learning new skills, prioritizing patient calls, communication, education, and support,
as well as now trying to juggle multiple benefit and network checks, calls to the provider,
obtaining a complete set of orders, scans, and pathology, and wind up unable to handle the
workload efficiently.
Stakeholders
The stakeholders identified include case managers, the education team, my peer assistant
manager, and a manager of case management. This team of stakeholders’ interest lies in ensuring
our current policy, training, and procedures support our new hire case managers in achieving
success within their roles. These individuals influence the policies, procedures, and continuing
education that are in place within our organization. The power that is associated with this team is
associated with their original roles, and collectively, this team has the power to execute this HIP,
to educate the staff, and to provide support in the completion of authorizations in the orientation
period. I am including both existing and new hire case managers as they are the backbone of this
Lori N. Keller
Western Governors University
Leavitt School of Health
Stephanie Hills
March 31, 2025
, D156: Business Case Analysis for Healthcare Improvement
Healthcare Improvement Project: Introduction and Project Initiation
Organizational Problem
The healthcare company is a comprehensive case management company that provides
case management and utilization review services to adult and pediatric populations. Consistently,
the turnover remains at approximately 20%, with most resignations occurring during the first
year of employment. The employee satisfaction surveys, orientation feedback, and the
information obtained during the resignation process have shown that one of the most significant
factors is the requirement to learn the case management process as well as the authorization
process for complicated multi-step authorizations such as chemotherapy and radiation therapy
within the first 3 months of training without the ability to focus on learning essential case
management skills first.
In our 1:1 conversations with new staff, the authorization process is brought up
frequently as a hurdle and as something the staff feels they need to prioritize over patient
outreach, communication, and other case management skills. While case managers are still
learning the basics of telephonic case management, this rapid introduction to authorizations has
increased turnover and decreased satisfaction. This Healthcare Improvement Project will aim to
develop a new position for Case Management Authorization Coordinators. These CMAC nurses
will primarily own the new hire oncology case manager’s chemotherapy and radiation
authorizations for their first 3 months of training, allowing for increased understanding of basic
case management skills, increased retention, and increased employee satisfaction while ensuring
quality patient care and customer service.
, Currently, new hire Oncology Case Managers must begin working on their own
chemotherapy and radiation therapy authorizations as soon as they complete authorization
training, around weeks 5-6 of orientation. Before they complete training, the team supervisor
would need to find an existing case manager who could take ownership of their authorization
through completion. This increases frustration for case managers already working on their
authorizations and carrying a caseload of approximately 60-65 patients. Once the new hire has
completed authorization training, they are expected to begin this authorization process
independently with little support from the education team. While they have a specialty buddy
and a mentor, many authorizations come over urgent from clients or providers with treatment
due to start within 24 hours. For new hire case managers, this is when the stress hits. They are
working on learning new skills, prioritizing patient calls, communication, education, and support,
as well as now trying to juggle multiple benefit and network checks, calls to the provider,
obtaining a complete set of orders, scans, and pathology, and wind up unable to handle the
workload efficiently.
Stakeholders
The stakeholders identified include case managers, the education team, my peer assistant
manager, and a manager of case management. This team of stakeholders’ interest lies in ensuring
our current policy, training, and procedures support our new hire case managers in achieving
success within their roles. These individuals influence the policies, procedures, and continuing
education that are in place within our organization. The power that is associated with this team is
associated with their original roles, and collectively, this team has the power to execute this HIP,
to educate the staff, and to provide support in the completion of authorizations in the orientation
period. I am including both existing and new hire case managers as they are the backbone of this
