Case manager in a hospital setting

  1. There is a case management position open at the hospital I work at. I have always been interested in case management, but I was wondering if any case mangers who are employed in a hospital setting can tell me about a typical day? For example, how many patients do you see? What do you assist with (discharge resources, setting up home health, durable medical equipment, etc....)?

    I have my BSN and two years of ICU experience.

    Thank you so much for your help!
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  2. 4 Comments

  3. by   MBARNBSN
  4. by   JVLims
    I'm a hospital case management RN at a 700 bed level 1 trauma center. My caseload is variable, between 40 to 50 patients. I have a blended role covering both discharge planning and utilization management. Typical day would include morning huddle focusing on that day and next day discharges as throughput is a huge issue-we are always short beds. Usually spend some time after that doing the less complex UM since my caseload is too large and diverse to attend all the interdisciplinary team meetings. Day is spent putting out fires, most discharge planning centering around arranging skilled home services, DME, with some home infusion or other more complex service. I do arrange SNF and acute rehab stepdowns, but mostly on weekends when there are only 3 of us covering the house. I actually like the weekends as I get to work across all services and be involved with patient populations and specialties outside my usual ones. Family and community support meetings also take up a slice of the day. I also work closely with the attendings, residents, and interns on our service lines. I love case management, it's a different challenge every day and I use all the skills I learned as a nurse who worked on medical, surgical, and intensive care units.
  5. by   dena_rn
    I have been a case manager in a small rural hospital for almost a year. I worked bedside nursing for 4 years before accepting this position. I roughly care for a total 10-30 patients at a time. I have the whole hospital, however, my director also helps when needed. We have a part-time case manager who also picks up when needed. But for the most part, I am it.

    I start my day reviewing the census to see who needs an authorization for their hospital stay whether inpatient or observation. I do my authorizations first thing in the morning because some insurances only give you 1 business day to request. On Monday, Wednesday and Friday case management performs rounding with the hospitalist to see who is discharging and what needs are out there. I will also make my own rounds on the patient's to see what their needs are when we don't round. I get the patient's choices for home health/dme/nursing home, etc... Then, I set the services up.

    The last part of my day will include reviewing the case management file in my office to make sure all elements of paperwork are met for compliance. We also have a program where the business office will send us accounts to review that are missing authorizations, Medicare one day stay reviews, and observation day carve outs. If the census is high, I can be very busy. Oh, I forgot to mention all of the phone calls we get.

    Some days I do not feel like a nurse anymore, and I think anyone could do this job. But, it can be very rewarding. Especially when that family who you have worked with to get their loved one placed in the nursing home tells you how thankful they are for your help. 99% of the time I feel like I have time to sit down with the patient and not be rushed because I have meds to give. It feels good to send that patient home safely.

    Good luck to you! I hope I gave you some insight on what it's like to be a case manager. However, each facility and position could be different.
  6. by   lisa41rn
    I work per diem in two hospitals. One hospital has a great reputation and you have 20-22 patients to cover. It's a lot but the MDs are onboard getting patients out. It runs really smooth.
    With the other hospital the most you have is 12 and the MDs allow patients to stay for no reason at all. It's frustrating. I'm not sure how they stay open to be honest. CMs don't do their jobs, complain all the time and are never held accountable. Was hopeful when a new manager came on board but she's worse than the previous one. Always on vacation or "working from home." There's a couple good CMs that bring the negative issues to her attention, with the hope things will be corrected, but they aren't. She views them as complainers. Can be this way anywherei guess.
    I think to have about 20 patients is about the norm. UR should be done separately however if you have that many patients you are managing. I do like CM but you need a great hospital with a supportive boss.

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