Yeah! I got my first CM Job!!!

Congratulation Lisa! Even though I've never done hospital CM, it's all tough to me. What you want to make sure is that you know and understand your role(s) thoroughly and learn how not to cross the line in getting your clients what they need or want. You'll have dozens of roles you'll have to play as a CM, some at one time. I wish you much success in your CM position.

Congrats on the new job!!!!! You should love it!!!

1) Medicare rules-for the most part, they will not make any sense-don't try to understand them just memorize them. Sometimes this will pose one of your biggest barriers to getting patients placed and meeting their dc needs.

2) Medicaid rules and reimbursement- they either pay for all or offer VERY MINIMAL reimbursement-some providers will not accept it due to this.

3)Commercial insurances-they have specific participating providers and reimbursements-you will become familiar with those who are common in your area.

4) If you are doing utilization review also-find out which criteria your hospital uses to determine hospital level of care. Most common ones are Interqual, Millman & Robinson. etc. You will become VERY familiar with this-it will be your Bible.

5) Become familiar with the pt demographic which you will be working with. IE if you are working w/geriatric population-know that most will have social issues, many will need nursing home or rehab placements or homecare. Important things to consider with this population- what is their current home situation, do they have support system, how safe is their ambulation-they can decline rapidly. Get a PT eval as soon as you feel pt may need to give you a sense of pt safety. Will the pt need Meals on wheels, other community rsources. Get Family involved from day 1.

If you are are working on a surgical or specialy unit like oncology-know the common dx and anticipate their potential needs on admission-start working to get your dc plan in motion ASAP. For example: if common procedure is colectomy w/colostomy-make sure pt is getting colostomy teaching as soon as appropriate. Anticipate need for services and referral to wound care nurse ( of course this is facility specific), if you are on an oncology floor-know that pt may need homecare for post chemo assessment,line care for central lines, iv infusion/ivf at home, social service support.

ALWAYS involve the pt & family (unless directed not to by pt) in dc planning.

ALWAYS have a d/c plan on admission-this may change but if you assess pt situation and anticipate needs you on course. You DO NOT want a D/C to de delayed due to poor dc planning ( your boss may not appreciate that) Of course sometimes this is inevitable

6) Be prepared to deal with difficult pt & families. Sometimes they love you. Many times you are the bearer of BAD news-ie Mrs Smith, you need a nursing home, mr jones, your insurance will not cover that medication , mrs X- I realize that you would like to stay here another 2weeks because you like the food here but your MD has discharged you, and your insurance company will not pay for you to stay here because you do not meet hospital level of care.

7) Sometimes you are the case manager, the dc planner, the insurance's reporter, pt advocate, RN, social worker,educator, community resource person, inverstigator,the roles go on & on & on & on.

8) There is soooo much information that you will learn as you go along. many peple this this is a cushy job-it is very challenging at times. But when you meet the pt's dc needs-especially those difficult ones-you feel a great sense of accomplishment.

Please let me know how else I can help. best of luck and congratulations.

Congratulations! What I tell my staff- No one dies because of the paperwork you do. Your job is never done in a day. When it's time to go home, you need to go home. Being a Case Manager is stressful enough without adding unnecessary stress to yourself. I've been in hospital based CM for over 20 years and came as a new nurse with a pen. Now using computers is a big help. Know your clinical area you'll be assigned to. It helps. Enjoy and keep us posted.

Congrats on your new position!

I was a CM in a hospital for 10 years. Included Utilization Review, Discharge Planning, Coordination of Care, Quality Monitoring, and more.

M&R and Interqual will become your two favorite lines of reading. You will come to memorize them, only to have them change again next year.

Will you be using laptops or
pen & paper?

Best of luck!

How's everything going on your new job?

Well I'm glad everything's going well. I started my first job as a case manager 3 weeks ago at a insurance company as a disease case manager. The first two weeks I felt like I was in Insurance 101. I learned about, claims, appeals, authorizations,etc,. But the third week we started focusing on disease management and it's specific role that I as the nurse would have. I'm so ready to learn more and more. I LOVE IT !!!!