A day in the life of a Case Manager...

d'cm · May 24, 2012

An ex hospital case manager responds:

1. On arrival to floor: Print census: Note: admissions, planned discharges, HMOs that need review and why the patient who should have left is still here.

2. Meet and Greet: Review new admits for utilization and potential discharge needs - and visit patients to introduce yourself and the explain the discharge process.

3. Possible rounds, staff meeting or both.

4. UR / discharge planning on the 20 or so other patients and often some on another floor when coworker is out.

5. Rounds with the Physcian Advisor

To actually do everything you are supposed to do and do it right would take about 16 hours a day and HMOs want their reviews by 2pm so there is constant pressure to work fast and there never seems to be enough time.

Definition of UR: reviewing the medical record and creating a concise summary of the reason for admission, what was done, what needs to be done including labs and vitals, and applying that to standard guidleines in the case managment software which then needs to be communicated to the payors - which can range from acutally calling them to autogenerated e-fax depending on the software used on both ends. Absolute Minimum 20 min per chart

6. I'm sure I left out a dozen things.

MintCondition · Aug 3, 2012

I am also curious to know what a typical day is like for a cm or UR from a work at home stand point. any inputs would be great to hear. thanks in advance

queen mother · Aug 4, 2012

hello d'cm, thanks for your post. It was very informative gave me some insight. Every bit helps.

remshowccm · Mar 17, 2016

Dear D'CM

Thank you so much for this information. Gives me an idea of what to expect if i am transitioning from CM in Insurance LTC to hospital setting.