Comfortable as a Case Manager

  1. Hi all!! I am new to case management. I am in the hospital setting. So far I am enjoying it... I do feel as though I have TONS to learn. Of course this is to be expected but how long would you say it takes before you start to feel comfortable in the new role ( I come from a floor nursing position)? Also any hints on how to learn the insurance requirements such as what they will and won't cover?? I know its different in each state, but maybe you would know the best way to become familiar with them.
    Also, this may only be happening in my facility, but there is a huge misunderstanding by other nurses and staff of what we Case Managers do... there even seems to be some hostility on their part. I thought maybe I was just extra sensitive since I am new, but I discussed it with the seasoned Case Manager training me and she stated that it has been like that as long as she can remember. Anyone else deal with this in your facility? Any suggestions you have to help me along in my new job adventure would be greatly appreciated!!
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  2. 4 Comments

  3. by   CaseManager1947
    :wink2: This is absolutely the neatest job I have ever had, and I've had a few over the years. Right now, I'm doing hospital-based acute care management, assigned by docs. Our new management team9@@@????!!!???) is going to divide by floors, making us unit based. hmmmmm decisions decisions.
    Down to your questions...it depends upon which hospital you work at which admission and care guidelines they use (two most common are InterQual and Milliman). These products are generally sold as a package deal, and that is what we base our data collection upon when giving initial clinical or concurrent review to 3rd party payors. So get you director to clarify for you who the hospital uses, and have them buy the book ($1,000)per pricey and i might add proprietary copy. You must know medicare/medicaid regs, what they will/won't pay for as OP , for example. There's really so much to know. I also recommend getting on either amazon or ebay and looking for some good books... can't hurt. About the stigma... we are perceived as having a "cush" job, push a pencil all day, blah, blah. They can make or brake your job, so I made an effort to go the extra mile, communicate my little heart out, whatever. Do what you'll say you'll do, basic really
    PM me if u want to talk more. I work in Kansas... I assume you are in Arizona. Also,, know you're clinical stuff!!!! Know your patient load!!!
    Occasionally, nurses have been known to help each other fail. Again email me and i can further discuss other details.

    Morghan, ARNP Kansas

    PS Did you get any orientation or were u thrown in the mix????
    Last edit by CaseManager1947 on Sep 15, '06
  4. by   SunnyAZRN
    Thank you for responding CaseManager1947 :wink2: I'm glad you enjoy what you are doing! I am a fairly new nurse and I was in training for case management for a short time and decided that my heart is in direct patient care at this time. Maybe I will try case management at a later time in my career, but I am glad I realized this fact early on. My hospital did seem to provide a good orientation for the case manager position which is so crucial for a good outcome for both the employee and the patients being served. Thank you again for all the great information!!
  5. by   AtlantaRN
    "About the stigma... we are perceived as having a "cush" job, push a pencil all day, blah, blah".....that is so true! i've been a floor nurse for 10 yrs, and I guess because the floor nurses don't really know what you do, they think you just call and get oxygen set up. they don't SEE, you working your heinie off to get someone placed; only to have the family say at 5pm on friday "we're taking mamma home." then you have to work your tail off to set up home health.................................or just the opposite, home health has been set up for days waiting for patient to go home; and then they say "we can't handle mamma at home!!!!!!!!!!!!!" AND THE RACE IS ON....placement after 3pm on a friday? forget it!

    I feel for you. I just took a job at a hospice where they call us case managers, however, it looks like the admission folks do everything, so I won't have to deal with that part; another hospice I work for, I do it all and it is a challenge especially when you don't exactly know when someone is going to be discharged.

    linda
  6. by   Merced
    To Sunny AZ RN: I think you were smart to do floor nursing if you are a fairly new RN. I think it's a job that takes a lot of self-confidence, the kind that comes with lots of experience in lots of situations.

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