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
Jul 19, '13
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 SummerGarden on Jul 19, '13