[moondancer]

I've been offerred a job in the hospitals' case management dept doing, specifically, discharge planning. Anybody focus on this role? Or is it combined w/other case mgmt functions?
I am really excired! I have been trying/wanting to get into hospital case management for some time now. I was working for an Insurance Co and really didn't like it very much....more internal stuff, not so much the job.
But I am so happy to have been offerred this position!
If anyone can give me some insight to this role, I'd be appreciative.

Thanks!!

[super_rn]

Originally Posted by moondancer

I've been offerred a job in the hospitals' case management dept doing, specifically, discharge planning. Anybody focus on this role? Or is it combined w/other case mgmt functions?
I am really excired! I have been trying/wanting to get into hospital case management for some time now. I was working for an Insurance Co and really didn't like it very much....more internal stuff, not so much the job.
But I am so happy to have been offerred this position!
If anyone can give me some insight to this role, I'd be appreciative.

Thanks!!

I don't want to sound negative, but the following is my experience. Hopefully it was just the institution and not the job.

I just quit my DCP job. It was horrendous--our hospital did not have a social worker, so not only was I responsible for placing patients, setting up HH and DME, contacting insurance complaines, etc...I had to do the entire social work aspect too (providing medication to patients, finding funds for patients, it goes on and on). It was too much for too little pay. It was a salaried position and I spent waaaay more than 40 hours a week there.

I really, really, hope your experience is far better than mine!

[moondancer]

Wow, that does sound horrendous! Well, this hospital has Social Workers, Case Managers and Discharge Plannersm so hopefully I won't be inundated with what you described. Good you got out!

[madmominavan]

Case Managers, depending the facilty ad the staffing and adjunct staff is for me a nurse who wears many hats. Havfing worked on the other side of the track with corporateinsurances and trade union insurances, the acute acre hospital takes a little knowing and studying so that one can meet the demands or criteria of medicare, medicaid, and any insurances and the facilities. Some patients don;t qualif for acute care and fall into cracks and I manage to lover level of care and get a negotiated rate for continuation fo care after saty an initial two days. I may also get ahome care company to follow and monitor ( never use the word in documanetationf or insurance coverages) and have a drug/pharmacy company set up meds and get a savings and arrange for a nurse to go out and train family or the patient. There is no end to what I may do becasue of the facility and the location in a University based hospital. Even in a smaller 380+ bed facility I am independnetly contracted as CMmy day starts with a to do list. I may have a max of 50-75pts., I may be covring someone who is off and have added responsibilities. I may have to on the spure of the oment get discharge pans or transfers in order and get pre-certs or other authorizationsl reports and the lot. Now mind you this smaller facility is NOT compterized and the nurses do not have computers to do their daily work or resports! OUCH! I am a tad spoiled having had the cat's pajama's in my other jobs ... evn homne care was computerized. I sty out of internal poitics as best I can but keep up with the bizz becasue it may affect my job or position... like the company who had a ceo who was taking money and out soruced the helath care /inurance end to an outside company who eventually minimized staff and eliminated our positions and sent the devision to their New Hampshire office and we took deductionsin salary and made to work longerhours for less pay and no perks. Not to mention we were forced to use their programs and be trained at our own cost to be fluent with their programs. Every facility is different as is every corporate insurnce company. But URAC , JACHO and many other monitors , state and local and national watchdogs exist and give us guidleines to be familiar with. Fortunately for me, I was on policy/procedure committe, continue education and several other committes which we all have a voice and can make a difference in the department to better or improve our department, case loads and work force. The down side s the pay scales which we contiue to bargain for and keep the Unions out of our dpeartment for obvious reasons by choice. Discharge planning is just a small piece of my job in the smaller facility. Some days I do what a social worker should have done and is not doing, buty I have many network and resources and do what is in the best interest of the patient and always try to negotiate and guide a patient and thier family to a moral , ethical and right decision. I do not o thier foot work and make referral and have a system to follow up with those I know will do other than what is right ormsuggested. I find funding for someon hwho has no coverage... my day is buisy and a never ending learning process.

[moondancer]

Thanks, madmoninavan! Sounds very busy! I myself, just got started...and it is really crazy, busy....but, so far, I really, really like it! We have a great staff of Care Managers and Care Mgr/DCP's, plus Social Workers. Even so, it is very busy and lots to learn!
I am looking forward to learning this end of it...I previously worked for a TPA/Insurance co, and really did not like it, this is so much better....for me, anyway!

[madmominavan]

Thanks for your respnse. Glad you found a nic...

[Lucy4]

I am a case manager at a major tertiary medical center and my primary responsibility is discharge planning. UR is separate. Some case managers do reviews and have a smaller case load but those hired as discharge planners in past 3-4 years are responsible for discharge planning. I prescreen all patients for potential needs - targeting those with readmissions within 30 days, age 75 or greater, no insurance (need to get immediate SW consult). The floor I case manage has many readmits due to nature of patient population. Also write reports for patients with 20 day or greater LOS each week - justify LOS and discharge plan. I facilitate placements to various levels of care - LTAC, SNF, acute rehab, home care. I set up patients with home antibiotic therapy - securing nursing agency and infusion pharmacy. Also order DME/DMR when needed. Occassionally obtain preauth for meds needed on discharge. Patients come to my hospital for highly specialized care and many from out of town/state. Also working with various payor sources when securing services/placements can be a challenge. The patient population I case manage often times has heavier care needs and med costs, therefore trying to place them with a medicaid payor source can be difficult (cost of care can easily exceed reimbursement). Private insurance will often carve out a higher reimbursement - medicare/medicaid HMOs do not - or maybe one in 1000. I enjoy the job and find it challenging. Good luck!

[ksilty]

Originally Posted by moondancer

If anyone can give me some insight to this role, I'd be appreciative.

Thanks!!

I worked for a while as a Case Manager for a Medicaid MCO. I did Short Term Case Management of patients being discharged from hospitals. My advise to you is to find similar resources in your medical community. There are a lot of horror stories around, but many can be avoided. You will find that a lot of your problem patients are Medicare or Medicaid. Most states have solid systems in place for case management of the Medicaid population, and Medicare is not far behind. I am now working for the State as a Medicaid Case Manager, and am working hard to forge a relationship with the discharge planners at my hospitals. They had no idea I exist. I could take a lot of the load off the discharge planner's shoulders very easily if I could get them to call me.......

[Lucy4]

The Medicaid CM I have spoken with RE patients are somewhat helpful. Often their hands are tied. Not long ago I requested assistance in SNF placement for an in state patient (Medicaid HMO). Several facilities were willing to take him but had to decline as reimbursement is $240/day and meds almost $100/day - not much left for therapies and incidentals. After multiple conversations between M/C CM and facilities, I told the M/C CM that there were 2 options - #1 carve out rate that is acceptable or #2 M/C will pay the hospital to rehab him in hospital (after DRG is paid - M/C pays by the day). In a hour she called me back - offered a special rate to the choice facility which was acceptable to them. One particular border state sends patients to my hospital for highly specialized care. Many are state medicaid. When these patients require rehab or LTAC placements - their home state has very few facilities that will accept. Finding a facility in my state that will accept these patients at out of state medicaid rates in nearly impossible. The out of state medicaid CMs are happy to have to not have to deal with these patients and their assistance, in my experience have been nil. At age 21 these patients have no SNF benefits. I asked what happens to these patients if hospitalized at home and was told they rehab in the hospital. Commercial insurance case managers that CM this specific patient population have more bargaining power and the great majority call me offering assistance before I have a chance to call them. I know I am off track here - just blowing some steam.

[moondancer]

Great discussion! Thanks for the info.... Lucy4, my job sounds very, very similar to what you describe. It is very involved and difficult,a s you say, w/the Medicaid population. Also, we deal a lot w/homeless and/or indigent individuals and that presents it's own set of challenges, of course. I am really happy with the job so far. I am definitely still learning, and there is a lot to learn! Fortunately, the staff I work with are all helpful, and the docs, nursing staff on the units have been great so far!
Again, thanks for the responses, it's good to know there are resources here....
One thing that does bother me, in my institution....we are about half and half computerized, the majority of charting, etc is still paper based. We don't have a lot of computer resources....it's taking a little getting used to, but, like everything else...I go with the flow....LOL!