[6079]

Would anyone like to share what a typical work day is like for them as a case manager?

I'd appreciate it in trying to figure out if it would be right for me. It seems like the best way to learn about something is to ask the people who spend their lives doing it, so that's why I'm here.

Thanks in advance to anyone who reads this.

[CaseManager1947]

Gee, looks like nobody has replied to your post... so here goes. My first order of the day, is to print off who has come in that is on my assigned list. We are assigned by doc right now. I then sign myself on the computer, and print my walklist. Next check the Insurance log to see if i have any calls to make, see if there are any new Insurances that need review. Check the new emails. Then head out to the floors. I try to avoid ICU's right too early, as the nurses have charts for report. Try to go by floors, or start with any known dismissals i have. We are to see each pt. daily, do an assessment on new admits. This has info on where pt came from (NH, home LTACH. etc), support systems, pre-existing services, (such as home health or hospice), current DME supplier, decision-maker, and see if they meet IP criteria. Also check admit order against how pt is actually admitted. Do reviews with insurances as pts. are seen, contact drs. about any problems. We also have a set of CM orders whereby we can order assessments and education needed in the hospital. I am with an assigned Social Worker, also. Facilitate any transfers, complete the paperwork for those. HMMMM. Case load varies from 18-25 or so

[6079]

Thanks a lot. I learned a lot more from that message than I do looking at vague descriptions I can find elsewhere. I appreciate that.

I'd like to know more about all this so I can decide if I'd like to try it. I understand if you're busy, but I had a few more questions.

Do you personally talk with the admits? Or do you mainly go over their documents instead?

What's your favorite part and least favorite part?

And what is the thing you do most often?

[eevie3940]

I’ve been in hospital case management for 3 years now, and previously, I worked at United Healthcare doing UR/DC planning for a year and a half. My day typically goes like this:
We have a case manager that is an early bird, so she usually picks up from registration face sheets of all admits. We have folders for each wing, so she does the admit-discharge-and transfer paperwork. She places all new admits to corresponding folders, takes out discharges, and patients who’ve transferred to/from icu, places them in the appropriate folder.
I take my folder and my list of patients on my side and review the chart for appropriateness, quality and continued stay criteria and enter the review in the computer for our admissions person to send it to the insurance carrier (if they have one).
This usually takes me about 2 hours. My load is running about 25 since we have a case manager that is out.
I then report to a 45 min. meeting to discuss clinical update as to why the patient is still in the hospital. This meeting is attended by the CFO, CNO, directors, accounting, coding, etc….
After the meeting, I start rounding for discharge planning, assessing patients 80>, chf, diabetic, copd, people who are from SNF’s, ALF, receiving HH services, etc…
We do not have a social worker. The case manager is the social worker. Some days are really bad, having to do the job of 2 people, but we have 201 beds in our hospital.
I interview the patient/family for dc planning. Some families can be really aggressive and want things done their way, or they want their family member in the hospital when they don’t meet criteria.
I don’t have a favorite part in the day- usually when its over I guess. The hardest part of the job is when you have a self pay patient that needs large amounts of care. Resources are very limited here in Florida, and usually you end up begging providers for home care visits, etc…
The activity most often performed in the day will be chart review. We review the chart every day. We know more about the patient than the primary care nurses, b/c nurses typically do 12/hrs and we do 8, so we are there 5 days a week as opposed to 3. We provide continuity, whether I see the patient everyday, I do know what is happening in their case.
I hope this helps. I am going to take my CCM in less than a week, and I’m nervous!

[CaseManager1947]

we are required to do an assessment, not a complete physical assessment, but a needs assessment, support systems, payor source (or lack thereof);
Sometimes I can't believe these gals have a license, as skin issues are missed, DNR orders not started, etc, Do a quick note about the cc, labs,tx, ivf's. iv meds, check to see if meet IP criteria, must see all clients every day. favorite part is making a difference in the lives of folks, someday gonna write abook!!!!! i guess the thing we do most often is deal with families (sometimes irate, sometimes crazy, sometimes unrealistic, sometimes illiterate /speak only croatian whatever the daily crisis may be, Right now I have a real interesting (hair on fire, trying to solve this one),,,
78 y/o man came back to hospital -- just released1 week prior from our sister hospital after hip pinning, Sent back toi Assisted living/residential home no skilled care. Came back to us with dehydration, acute on chronic renal failure, hip is draining, etc, Now on dialysis, dobhoff down, etc etc. There is no family willing to help ( gent had spent 27 years in jail for murder, so is estranged from family. MY job... figure out how to pull a DPOA out of my hat!!! working on that this week. I love a challenge.. Poor little guy is so confused..... i do get a lot of elders with no advicacy at all.

wish me luck

[IngyRN]

Best part of my day: when you get that difficult, almost impossible, pt discharged to an optimal setting ( not just that crappy NH that you know for sure the pt will come back with ulcers, FTT, etc) or that self pay that REALLY & TRULY has NO resources and are to get them hooked up with community resources

WORST PART: the irate. irrational family/pt that EXPECT the IMPOSSIBLE and accuse you of incompetency because you cant get the pt everything for free, or into that Acute rehab (while the pt doesnt quality), or the NICE NH, or my favorite" I dont understand why you are kicking me out of the hospital" I have to constantly remind them that case managers ARE NOT MD's- we dont write d/c orders but if the pt is not HLOC it is our job to find the ALOC.

Thanks for letting me vent . As you can imagine I had a hellish week- I appreciate being able to vent.