We have all heard the term "emotional intelligence (EI)," a phrase made popular by author Daniel Goleman (1995) to describe the ability to manage one's emotions and to understand those of others. Just as EI is linked to greater success in business and in life, I believe that case managers (CMs) have their own brand of intuitive knowing, which I call "CM intelligence."

In addition to the knowledge, skills, and expertise, the CMs must possess and demonstrate, our CM intelligence encompasses the savvy knowing and nuances that go with this field. CM intelligence comes from time and experience, but also draws upon the internal intuition that each person has.

Certainly, CMs must demonstrate that they have the requisite skills, knowledge, and experience to competently practice in the field. The Commission for Case Manager Certification has specific criteria to become a certified case manager based on the roles and functions of CMs.

The requisite knowledge and the skills we have acquired, however, are also enhanced and complemented by the internal qualities that mark a successful CM. On the basis of my own experiences and observations, here are some of the elements of CM intelligence that we call upon as we carry out our responsibilities and duties as CMs.

Touch

In the hospital where I work, a physician told me that the better performing CMs in my team are those who had, what he described as, the right "touch." This has nothing to do with physical contact, but rather, sums up the ability to communicate with physicians, patients, families, and any other involved party in such a way that everyone feels heard. Working with patients, in particular, CMs who have the right "touch" convey that they are really listening and that they really care. Even when a CM has to explain that a payer will not authorize a certain treatment, or that a particular resource is not the best one for the patient at this time, with the right "touch" the patient will still feel heard and understand that his or her needs are being met in the best way possible.

Read

The CM who has a good "read" on things knows how to approach a physician who tends to be gruff, how to establish rapport with insurance company personnel, and how to communicate and engage in active listening with a family who is upset or challenging. To be an effective advocate, the CM needs to be able to read people, circumstances, or other interpersonal dynamics (e.g., among a patient's family) to establish open communication among all involved parties.

Sense of Urgency

Regardless of the setting in which CMs operate-whether in a hospital or other care setting, a private firm, or as a consultant-they need to have a sense of urgency to manage competing priorities. This means operating with a global understanding; for example, not only the complexities within a particular case but also the complexities among several cases. As priorities shift and change, the CM's sense of urgency allows for quick responsiveness.

Openness

We live and work in an environment rich with ethnic and cultural diversity. In a hospital, in particular, patients are of all ages and ethnic, religious, cultural, and language backgrounds. This requires CMs to be open and accepting in their interaction with others, including those whose cultural dynamics may be different, such as methods of decision making. At the same time, CMs should be aware of body language and cultural customs that may cause a person to appear as though he or she understands or agrees with what is being said, but may only be nodding out of politeness, not giving consent.

Empowered Neutrality

While being neutral and objective, CMs are obliged as advocates to make sure that they are empowering patients and their families to make informed decisions. For example, a family decides that they are going to take the mother home from the hospital and care for her by themselves. The CM is concerned that they do not fully understand the complexity of her care. Instead of interjecting her opinion, she arranges for the family to care for the mother for 24 hours in the hospital to make their own informed decision.

Boundary Development

As advocates, CMs can get caught up at times with the wants and desires of the patient and(or the family, and lose sight temporarily of what is in the person's best interest. With healthy boundaries, the CM can still be an advocate while maintaining the perspective to see what a patient needs, as well as those resources that are able to be obtained under the constraints of the person's benefits.

Benefits Savvy

In a society in which healthcare is not a right, but a privilege, not everyone gets the same care. To a large extent, treatment is determined by coverage, whether a Preferred Provider Organization, Health Maintenance Organization, Medicare, Medicaid, or other benefits. With benefits savvy, CMs can obtain the best possible care and treatment resources within the reality of a person's coverage. Often we see this with uninsured patients who are treated at a hospital, but as the CM works on a discharge plan, the reality for this individual makes the job difficult. In fact, I believe some of the most creative and resourceful discharge plans are written on behalf of patients, many of them being indigent, who have no insurance.

CM intelligence speaks to different aspects of our role as advocates. The nuances of our responsibilities to provide access to the right care and treatment resources at the right time will be experienced and expressed differently given the CM's job function and career level. Yet, all of us need CM intelligence-the intuitive skills and the level of savvy knowing that come with experience. As we draw upon our knowledge and experience, remain attuned to our CM intelligence, and keep an open mind, we are best able to address the needs of patients and families in today's complex healthcare arena.

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