Novice seeking advice from expert CM

alintanurse · Jan 8, 2005

Hi:
I just started a new job as a CHF case manager dealing with medicare beneficiaries. During my interview, I asked how long the training was. They said 6 weeks. My "training" consists of giving a bunch of manuals to read and sticking me in front of a computer. I don't know the slightest thing about medicare or how it functions. I've been told "no question is a dumb question", but when I ask, I'm looked at like I'm from another world. Example: I asked "where can I get a list of medicare certified h/h agencies". Well, my manager looked at me like I was dumber than dumb. I'm not willing to fail and I'm not going to give up. I have problems looking for resources for people who say things like, "I am not financially well off, what can I do"? Please help.....you guys are always so great on this forum and am hoping you can give me suggestions on how you organize your workflow and a list of resources that you most often use.

okay, now I want to be helpful --what kind of organization do you work for? At this time I would suggest that you call your area home health agencies and ask if they are medicare certified,some only deal with medicare-some deal with medicaid,medicare,HMO'S and PPO's. I'm assuming you want only the home health agencies that are local.and then you can compile your own list. As far as finding resources-do you mean teaching material? Government websites offer material that is usually free. How about approaching a social worker for help--is one available to you? :rolleyes:

Trauma Columnist · Jan 8, 2005

Can you contact another nurse doing a similar job at another hospital? Another option might be to contact the inpatient case managers and I would bet they would have the lists you need. Does that help?

hoolahan, ASN, RN · Jan 18, 2005

What kind of setting are you in? Managed care? Hospital?

You could ask a social worker about resources, but if you are in an HMO type setting, I imagine your area served in larger than say one county.

Please tell me more about your position and work setting, and maybe I can help you.

You may also be assuming that all your pt's wil need homecare, but Medicare only covers home care if a pt is homebound, so you will need to find different resources to refer people to as well.

Do you have a program in place? A disease management program? Care pathway, something like that?

hoolahan, ASN, RN · Jan 18, 2005

PS everything you want to know about Medicare can be found at http://www.cms.gov

There may already be info that you need there re CHF requirements or standards of care for CHF'ers.

minneRN · Jan 18, 2005

Thank you traumaru's!!! I took your advice and it worked. I contacted one of the case managers at the hospital I used to work with and it led me to some great resources. It has been almost a month at my new job, and I have found that most of the nurses there are scrambling just like me to find resources for these people, and it made me feel better because I thought that I was supposed to know this stuff already....well big surprise for me. Thank you for sharing. It is really appreciated.!:)

Can you contact another nurse doing a similar job at another hospital? Another option might be to contact the inpatient case managers and I would bet they would have the lists you need. Does that help?

minneRN · Jan 18, 2005

Dear Hoola!

Thanks for your advice. I work for a MCO, but, I am a dedicated case manager only dealing with medicare patients in a research study for CMS on CHF patients. Interesting huh? The SW suggestion is great, I will try that. Our program is a disease management program. So my job is to reinforce the disease specific education by the DM nurses and to assess the living situation for any needs that arise, i.e. in home support services, DME, H/H safety evals, transportation resources. Currently the Internet is my best friend! I have patients all over the state of CA and AZ. Anything else you can offer is great. You are great!

What kind of setting are you in? Managed care? Hospital?
You could ask a social worker about resources, but if you are in an HMO type setting, I imagine your area served in larger than say one county.
Please tell me more about your position and work setting, and maybe I can help you.
You may also be assuming that all your pt's wil need homecare, but Medicare only covers home care if a pt is homebound, so you will need to find different resources to refer people to as well.
Do you have a program in place? A disease management program? Care pathway, something like that?