Calling all ER case managers

madmominavan · May 11, 2008

Go online to the Case Manaers association. Join or get your employer top pay for the membership. There is a gide book on line you can print out. Get the case manager's handbook, Borders or Barnes and Npbles carry it or will order it. Hospital based Cm has similar guides and jopb descriptions. I can look for mine and fax you a copy. I have worked both sides corporate insurance agent and in hospital. I also cover the mental health side since I have a back ground in psych. It is mostly drug & ETOH. As Er CM you have a 24-48 hr window depending on the state you are in to get the ER info to the UR/insurance. If the client is admitted or a 23 hr client. Be sure your state & facility has guidelines if you need to be certified in any other states. I get transient patients and have to be certified in several states, like NY, NJ, Delaware, Flordia, etc. Alot of our patients come to this area for heart surgeries from all over the USA and abroad. I have a child who is from Puerto Rico without insurance. I cover the ER for a colleague. I am not required to work the ER. I get a report from the dept and then from the ER. I follow who is getting work up, admitted or are ER hoppers. Call attendings or primary doc, liason with specialist and primaries, make sure the patient/family has referrals and networks or see that there is a discharge plan for either the Er or that they are admitted and will be inhouse for procedures. I also make sure procedures are timely and that because a doc ios off or not in that there is no delay and we would get a denial. I call reports to UR and Cm at insurance companies. I may see patinets who need to be motivated to get out of bed and will approach anurse toget organized and attend to the patinet to get them up and about becasue of the authorizationl I also act as an advocate for patients who know little about insurance and guide them. You can not do thier foot work. I also let them now what they are eligible for and that entitlement and genrally things are not free... always some co-pay. I have a great network of services and referrals. I also follow up on patinets who may come back for one reason or another. I watch frequent flyers in the er esp. ones who are drug seeking or have not given acurate information. Chart reviews are time consuming but necessary. We use Interqual, Robertson, Miller and Pediatric Guides that help us get authorizations based on acuity. I may have to try to transfer a patient for a procedure or negotiate for lower level of care if not an acute admission. Some days I have atients coming and going. I try to capture savings and keeping thier admissions acute and try to get outpt. services initialted if I can beofer going to the floor or pass on the info to the nurse for the case manager that will cover that day or the next. It is about being knowledgeable and organized and wearing many hats. CMA also can help you with a standard generic job description if you don;t have one inplace or if it needs to be updated. Good luck. I find this position to be very rewarding. I get alot of rewards and perks from my patinets... meaning thank you's.

madmominavan · May 12, 2008

I will look for these items and fax to you. I am in process of cleaning out and moving. I have three households in my living room, dining room and bedrooms. My mother died and I sold her house and my aunt, her siwster died recently and i have all her things to liquidate and settle her estate. But, I will get the info to you.

Startt by going online to aamcn.org and the ana.org Memebership fees are high but worth it, if you can get your employer or human resorces to pay the fees. It is a tax write off. I am a member , get CEU's, have acces to updated information and legislation, etc. I attended a conference which was awesome and packed with information to take back. I found a computer info program to try for our dept since we are still doiing everything by hand and on paper!

madmominavan · May 12, 2008

Go online for the handbook... buy a used copy... there is one on amazon for $2. & change + shipping.