What type of Nurse Case Manger are you?

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    Hello I am Laydiebuug and I am a Pediatric Case Manager for an MCO. Prior to coming into my new position I worked at another MCO that specialized in Special Needs Pediatrics and I managed the OB program which I adored. My ultimate goal is to Case Manage in my own non-profit just to single battered women and teenage mothers. I am also working on my BSN. I am office based now, I used to be what is called a hybrid in my last position which had a lot of perks but I don't miss it that much. So are you guys hospital based, HMO, MCO, State, or private? What do your main duties consist of? How did you end up in Case Mangement? Do you plan to stay and do you miss bedside nursing if you were bedside? Just trying to break the ice. Feel free to ask me whatever
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  3. 9 Comments so far...

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    MN, RN-BC, CCM, buncha other stuff.
    Private, catastrophic, 99% adults, but CM is now only about 15% of my cases. (The rest are life care plans and legal nurse consulting.)
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    legal nurse consulting as always peaked my interest, I am a few credits away from my associates in paralegal studies...I was doing that once upon a time ago when I thought my disability would keep me from nursing. Do you like it? How intense is it, and what types of cases do you look over?
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    I'm an ED CM and a Hospital UR/UM Nurse (I have two jobs because I like them both). Within the ED I support the discharge, transfer, and/or admission of patients from the ED. I collaborate with the IDT to include the ED and Admitting MDs, the primary nurses, the patients, and family/support systems. In other words, a lot of analysis, critical thinking, and social skills are involved in caring for and evaluating my cases. I also refer cases to Social Work when needed.

    In some facilities the CMs in the EDs are expected to be (act like) MSWs. Although I have an extensive knowledge base that I am always building upon to perform my job as a Nurse Case Manager successfully, I make it clear to my patients and the IDT that I am not an MSW and that I am no substitute for a licensed experienced MSW (In other words, I do not step out of my scope of practice because it will be convenient to the IDT and/or the patient).

    As a UR nurse I perform reviews and negotiate with insurance companies to get my facility paid for patients that are either currently in the hospital setting or who have discharged. Both jobs can be stressful due to the amount of duties an responsibilities assigned to perform the job, however I love being a Nurse Case Manager and am working to continue to do so for many years to come.
    Last edit by MBARNBSN on Jul 19, '13
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    Quote from laydiebuug
    legal nurse consulting as always peaked my interest, I am a few credits away from my associates in paralegal studies...I was doing that once upon a time ago when I thought my disability would keep me from nursing. Do you like it? How intense is it, and what types of cases do you look over?

    Love it. Check the American Assoc of Legal Nurse Consultants, American Association of Legal Nurse Consultants (AALNC), for information.

    You need to be an RN to be certified as an LNCC, the only certification that's recognized by the board of nursing specialties. There are other "LNC" courses and "certifications" which are basically not certifications but what the owner of the course issues you for attendance, not independently verified by examination, hours in the role, etc., and there are some passionate arguments around this in the legal nursing forum.
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    "The p.o.'d, frustrated, can't believe the how dysfunctional our health care system still is" kind.
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    Home health/pediatrics.
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    Just starting in high-risk OB for insurance company/medicaid. Lots to learn!
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    Quote from serenity1
    Just starting in high-risk OB for insurance company/medicaid. Lots to learn!
    I do pediatrics for insurance company/medicaid, I used to do special needs OB for medicaid in another region. You have a lot to learn but its interesting, I loved OB
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    I am the lead case manager in the med surg floor of my acute hospital. I got my masters in nursing with an emphasis in case management. Its stressful at times but i love it
    GrnTea likes this.


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