Case Management Qualifications

Specialties Case Management

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:balloons:I am a case manager currently completing my Bachelor's degree and am working on an assingment for school.

I would like to get opinions from current case managers as to the importance of having clinical experience prior to going into the case management field?

I have been a Nurse for 20 years with all acute care expeiance. I am a LVN Nurse Case Manager and have been for the past 6 years, of course I have an RN in the office over me and I love it. we have a 20-23 patient load and we call all of our UR into The Ins, Case Managers we do it all! I have a lot of Med. surg. background! Most hospitals do not have LVN's as CM. Lots of Ins, Companys do.

I have an ASN , a BBA in Health Care Admin and am almost finished with my degree in HC Mgt. I think the 4 year degree is what matters as long as it is in the healthcare field. I have just taken a CM job - had my choice of 3. I think more companies are looking at well-rounded experience.

Specializes in ER/Critical Care/Case Management/PACU.

well, i had no case management experience when i was hired, but what got me the job was the 15 years of ed and critical care experience that i had. i learned the case management part of the job as i went along, but think i would have completely failed had i not had all that clinical experience. in my opinion it is next to impossible to manage care if you have no idea where that care should be heading.

Specializes in OB/MedSurg/Home Health/Case Mgt.

Having experience in home health is a big plus when considering CM. Our hospital requirements: BSN and 5 yrs clinical experience.

There is no way you can do case management if you don't have the clinical experience. For one, case management gives you autonomy. If you don't know what really happens clinically in any one disease or injury then you can't possibly develop a plan of care or direction, you can't possibly discuss treatment with the physician and make recommendations of treatment if you don't have the knowledge/experience to do that. (It won't take long for a physician to realize you don't have the knowledge or the experience and they will eat you alive). Case management is considered advanced nursing because you have to be able to think critically and there are a lot of people depending on you for recommendations of treatment if you work in the work comp or disease management field. With work comp you frequently are working with attorneys and you have to know what you are doing. Sorry for being so strong but I've been in case management for 15 years and I had 16 years in the hospital and it has been hard working as a case manager.

The hospital system I use to work for recently instituted that all CM must have at least a BSN w/ clinical experience. The insurance company I just started working for just instituted the same requirements. The same insurance company seems to also not hiring anymore LPNs in the medical dept.

I guess as more research comes out about adverse outcomes, the hospitals & other medical facilities feel if all else fail, at least they can brag about having all RN this, and all BSN that. It does look good on paper at least to the general public. You can always impress people with titles & degrees.

Specializes in Med/Surg; School Nurse.

I have been working for an insurance company now for 7 years all in the Medical Management dept. I am currently in nursing school for my RN and my boss is desperately trying to talk me into coming back after I graduate to run the department. I am undecided about what I want to do as I very much agree that clinical experience is a must for case management but do I want to start at the bottom rung on the ladder? Any comments would be greatly appreciated.

Specializes in Rehab, Spinal cord, UE amputations.

Extemely important, especially since you are making recommendations to possibly adjusters. You need to be able to understand what you are doing, especially if you go into telephonics like me. I handle mainly upper extremity injuries and attend many inservices and will spend a day a month with an MD following cases to keep my skills up in new areas of treatment

Specializes in Med/Surg; School Nurse.

Thanks for your input. I have since quit my job so I can focus on school only. Right now I don't think I will go back to insurance until I have a couple of years on the floors.

Specializes in Psychiatry, Case Management, also OR/OB.

I've been doing hospital-based case management for about 10 years. It is my belief that a solid clinical background is essential for case managing clients, whether that be in hospital, OP, or insurance settings. There is good research that suggests shorter LOS, better outcomes and follow-up with case managers supporting the patient and family. I had experience in med-surg, OB, surgery and psych before getting my case management position. Our hospital requires Master's Prepared case management nursing staff. Others do not. Knowledge of available resources, Medicare and Medicaid reimbursement and regs, are all essentials as well.

Specializes in ER,PACU,Urgent Care,ICU,ltc,.

I applied for a case mgmt position at my hospital. There are 7 or 8 new openings, so I figured they would be willing to train at least a couple of them! My dilemma is that I have mostly ER, out pt urgent care, and recent PACU experience. I have not worked on the floor for 18 year, and that was ortho/neuro and ICU. Are there new positions for Emergency Dept case managers? It seems to me I recently overheard one being assigned to ER for management of pts. with chronic illnesses, and frequent fliers, and/or drug seekers. Maybe I misunderstood. At any rate I have 23 years experience and have tried many different areas, including some OB office, surgeon office, nursing home--long ago- but mostly ER stuff. Am I out of my league? I'm afraid I'll be a fish out of water, but I really need to get a less stressful job than ER. And I hear so many positive things about case management. I can't say I really understand it completely though, but I'm alwayswilling to learn new skills!

Any input or advice , recommendations? Would an Ins. co. be a better route for me?

how about disease management for an insurance company? then you might move up to case management later? i have 20 years of varied nursing experience and went to disease management and love it

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