Starting as a case mangager in 2 weeks

lynnr_98, BSN, MSN, RN · Oct 7, 2008

I've been working as a WC Nurse Case Manager for a few years. Previously, I was a FCM (Field Case Manager), but now work as TCM (Telephonic) so I never have to leave my house. :)

1. You bill for basically everything that you do. Every call, report, letter, fax, email, review of records, etc., is billed based on the amount of time it took you to do it. I normally bill 0.2 for phone calls unless the call is lengthy and then I bill 0.3. If I just leave a quick message, I'll bill only 0.1. Letters could be from 0.3 to 0.5 depending on the length and if they are a form letter or something I wrote myself. I normally bill about 1.0 for reports.

2. As a TCM, I'm reimbursed for my office line, fax line, internet, postage, and office supplies. If you work as a FCM, you will also be reimbursed for your mileage and your cell phone.

3. My typical day usually starts with me checking my email and printing out my to do list for the day. Most of what I do involves follow-up on on IW's appointments, therapy, etc. I call doctor's offices, clinics, physical therapists, etc. to see how they're progressing with treatment and to see what their work status is and the date/time of their next appointment. I ask that medical records be faxed to me, review them when I receive them and forward them to the adjuster. If the doctor requests something like therapy or surgery, I submit the request to UR to review for medical necessity. If the request is certified, I assist with arranging the therapy, surgery, etc. It's a lot of following up on things and coordinating care.

I'm really not a day person, so I don't start working until around 11 am. I then make all my calls during the day when offices are open and just dot my notes down on post-its. I then take several hours off in the late afternoon to do things around my house. I don't enter my notes into the system until the evening. Most nights I enter my notes from 8 pm to midnight. Other nurses like to start early and finish early. It's a very flexible job. I love that my supervisor doesn't care when I do my work, as long as I get it done. Hopefully, you'll like the job and will have a flexible supervisor also. It's definitely going to be a change from L&D! Let me know if you have any other questions.

DM66 · Oct 7, 2008

:yeah:Thanks for the input. You've really cleared up a lot of the questions I had. Sounds like you've had some really positive experiences with FCM. I hope to also. I'm looking forward to the flexibilty of the job. Any suggestions about the difficulties with the job would be helpful. A few more questions: how large was your case load, when you were a FCM how many appointments did you attend and are the job responsibilities about the same as with TCM? Thanks again!!!

lynnr_98, BSN, MSN, RN · Oct 7, 2008

When I was a FCM, I had a caseload of about 20-25 files. I would attend 1-3 appointments per day although some days I had no appointments. The hard part for me was that after driving and attending appointments all day, I would come home and want to take a nap insteading of doing my work. Because I was too tired to do my reports, I would postpone them until the weekend. Then I'd be mad that I was working on the weekend. A lot of FCM's end up working on the weekend because they don't get their work done during the week. It does get tiring being on the road so much. At one time, I was working for two different companies as an hourly employee and was covering a HUGE area. I would end up driving hundreds of miles in a day. That really wears on a person.

Now that I'm a TCM, I have about 60 files. The responsibilities are the same except that I don't actually attend the appointments. I just call the doctor's offices and get their status over the phone. I do miss being out and about in the world at times, but I'm saving a ton of money just working from home. I don't have the wear and tear on my car anymore, I don't have the expense of eating out or buying nice clothes, etc. I think even my car insurance should go down now that I hardly put any mileage on it.

My biggest advice for you is time management. While your waiting for the IW at an appointment or in between appointments, make as many calls as you can so you don't have to do it when you get home. I know many FCMs take their laptops with them and work on case notes/reports while out in the field. I never liked doing that but it works for some people.

Good luck with the new job! I hope you like it! Let me know if you have anymore questions...

DM66 · Oct 7, 2008

Thanks again for all your answers. A few more questions. What is the typical length of a case? I was told in one of my conversations (pre screening phone call before I actually got an interview) that there is an opportunity to make extra money via bonuses for time billed over the required minimum, was this true for you as well? Also are the IW happy to have a CM or not really and also how often did you have an IW that was trying to take advantage of the system?:wink2: Th:wink2:anks

lynnr_98, BSN, MSN, RN · Oct 8, 2008

The length of a case varies. Some are only task assignments to attend 1 appointment and therefore last for only a week or so. Others can last FOREVER it seems.

As far as bonuses, the company I work for now doesn't offer them because a lot of us have flat rate files, meaning the company only gets paid a flat rate no matter how little or how much the nurse does on it. A lot of other companies do offer bonuses, but I have to say, that most nurses I know, never received one because they never billed enough hours to get a bonus. When I was a FCM, I always worked as an hourly employee or an independent contractor so that I was paid just for the work that I did. If I felt like taking a lot of files, I made more money. The times when I was lazy and didn't want to work too hard, I'd take less.

As far as the IW's, you'll see all kinds. Some are happy to have a nurse helping to coordinate their treatment. Others feel like its an invasion of their privacy to have the nurse attend their appointments (those are usually the ones who are trying to milk the system). There's also some doctor's offices that do not cooperate with FCM's and won't let you attend the appointment and other offices that are very FCM friendly. You'll see all kinds and have to adapt to the various people. It's definitely not a boring job! :)

DM66 · Oct 8, 2008

:nurse:thanks for all your help, you've cleared up all the questions I have so far. I start next week and I'll let you know how it's going. Thanks again!!!!!!!!!!!!

lyv33 · Oct 29, 2008

I am going to disagree with you that it's not a boring job. I have been doing FCM for 4 years and I think it is the most boring job ever. It's mostly paper work, waiting at MD appts and f/u phone calls. But it beats being on your feet for a whole shift or doing an impaction removal.

bambi227 · May 3, 2009

Do you have any suggestions for how to obtain a position such as yours? I have been trying for some time with no luck at all.

Thanks!

lynnr_98, BSN, MSN, RN · May 3, 2009

If you want to get into WC case management, you should start by taking a class in WC as most companies want you to have a basic understanding of WC laws in your state. I took a class at a local college prior to getting my first job as a FCM. I'm in CA and have also taken classes at Insurance Educational Association (http://www.ieatraining.com). When I interviewed for my first WC job, they were very impressed that I already had taken classes on my own and had an understanding of WC. Hope that helps!

bambi227 · May 3, 2009

Thanks Lynn!

I currently do WC for a facility so I am pretty familiar with the laws, etc. I am really just having trouble finding the jobs to apply for out there. Our insurance company is Broadspire so of course, I looked there. But they do not have any positions in our area at this time. Unfortunately, I'm just not very familiar with all of the organizations that do that type of work.

bknyrn · May 3, 2009

I just accepted an offer to work for a medical case management company as a wc case manager. Can anyone out there tell me what to expect as I am leaving bedside nursing as an L&D nurse?
How does billing work
What kinds of expenses are reimbursed
Typical day (if there is one)
Thanks for any input:typing

What company are you working for? Anyone hear of Medical Case Management Group (MCMG)?