Case Management Hurdle

[sunzzi]

Hi!!! Everyone,

I am a new Case Manager in the Pediatric Sub acute Facility with no one to orient me at this time. I am trying to educate myself, but have been unsuccessful to find the information pertinent to Peds Subacute Case Management.

I feel frustrated while dealing with the Insurance as well as getting authorization. As I am in CA, I would love to hear and really appreciate to get some suggestion regarding the baby steps towards the Case Management.

Thank you.

Sunzzi

[IngyRN]

I am confused. Why did you not get an orientation?? Where is your manager/colleagues for resources?? What i your background? Finally are you doing UR & dc planning or just UR??

As far as dealing with insurance, your facility should have a criteria set (ie Interqual or Millman & Robinson). You follow this criteria, along with your nursing judgement &guidance from your medical diector to determine whether the pt is at the appropriate level of care.

I am a case mgr on an adult med/surg & oncology unit. Let me know how else I can help.