Case Management Hurdle | allnurses

Case Management Hurdle

  1. 0 Hi!!! Everyone,
    I am a new Case Manager in the Pediatric Sub acute Facility with no one to orient me at this time. I am trying to educate myself, but have been unsuccessful to find the information pertinent to Peds Subacute Case Management.

    I feel frustrated while dealing with the Insurance as well as getting authorization. As I am in CA, I would love to hear and really appreciate to get some suggestion regarding the baby steps towards the Case Management.
    Thank you.
  2. Visit  sunzzi profile page

    About sunzzi

    From 'Irvine, CA'; 33 Years Old; Joined Sep '05; Posts: 56; Likes: 1.

    1 Comments so far...

  3. Visit  IngyRN profile page
    I am confused. Why did you not get an orientation?? Where is your manager/colleagues for resources?? What i your background? Finally are you doing UR & dc planning or just UR??

    As far as dealing with insurance, your facility should have a criteria set (ie Interqual or Millman & Robinson). You follow this criteria, along with your nursing judgement &guidance from your medical diector to determine whether the pt is at the appropriate level of care.

    I am a case mgr on an adult med/surg & oncology unit. Let me know how else I can help.

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