career choices CM orUR

2amigos · Aug 26, 2002

Good question- I am in the same boat as you. I noticed in the newspaper an ad for a CM. You needed eithe certification or a MSN in Case Management. I'm not opposed at all to getting my MSN, but is that the best route?

Cheryl

LasVegasRN · Sep 12, 2002

The two are kind of inter-related.

Case Management involves coordinating the care of the patient throughout the continuum, depending on the setting you will be doing the case management. Right now most of the case management jobs are in workers compensation, group health for high-dollar diagnoses, and catastrophic case management for conditions such as organ transplants, AIDS, burn patients, etc.

Utilization Review/Management is using established criteria (such as Interqual, Milliman & Robertson, or the company-developed policies) to determine medical appropriateness of authorization requests and facility length-of-stay's. This doesn't always require patient contact, unless you are doing utilization management in the hospital setting for discharge planning purposes.

When I hired new nurses for our case management department, I liked them to have a background in utilization management. Although it's not always necessary, it was definitely helpful when they has cases where their patient were admitted into the hospital and they needed to authorize their length of stay, home health orders and DME orders.

nurse555 · Sep 13, 2002

Thanks for the information. Most people I've asked act as if they don't want to be bothered so I appreciate your help. I'm trying to decide if I want to get my BSN or MSN after I finish my ADN and these areas interest me. Thanks again!

Robin

ryaninmtv, ADN, ASN, BSN, MSN, LPN, RN · Sep 14, 2002

I agree with LasVegasRN in the case management and UR are related. Where I work, we provide both services. With UR, we're looking for appropriateness and cost of care either on a prospective, concurrent, or retrospective basis. With case management (especially in workers comp) we try to guide the client through the system and help them return to work as quickly and safely as possible. Both are growing fields. Good luck.

nurse555 · Sep 14, 2002

Thanks for the input. I appreciate it.

LuvLife · May 5, 2003

I know this thread is rather old, but I am interested in getting in to case management as well. There is a college that offers a Bachelor Degree in Health Service with a concetration in Case Management for nurses with a Assoiate Degree. I was wondering if this is a good way to go. There is also a conference coming up about Medicare/Medicaid reimbursement and was wondering if this would be benificial or too far over my head. I am currently working as a staff nurse in LTC.