Case Management Hurdle

  1. 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

    Joined: Sep '05; Posts: 56; Likes: 1
    ICU nurse; from US
    Specialty: Case management, Peds, ICU, Med/Surg


  3. by   IngyRN
    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.