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Case Management Nursing (CM)

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Case Management is the nursing involved with the business of length of stay. Incorporation of InterQual or another ranking system, the CM determines length of stay based on numerous factors. There are also other CM models so individual jobs will vary.

Specializes in Nephrology, Cardiology, ER, ICU. Has 29 years experience.

What does a case management nurse do?

Case Management Nursing (CM)

Case Management encompasses several models depending on the work environment. In the hospital, the Nurse Case Manager (CM) is frequently utilized to determine the length of stay and incorporating individual patient dynamics into the equation.

Interqual (an evidence-based clinical decision support solution) is the resource most facilities use to determine the qualifications of patients with regards to their admission length. Nurse Case Managers work with physicians, other nurses, ancillary personnel as well as the patient themselves. Interqual is a proprietary program that is sold by McKesson and purchased by facilities.

Case Management encompasses risk management as it relates to the patient's length of stay. With the drawing down of hospital personnel and the tightening of purse strings across the board, CMs are seeing expansion of their roles in the hospitals. Some CMs are even doing discharge planning.

Another CM model is that of the RN responsible for a set of patients that are at high risk for readmittance to the hospital. The CM works with them to determine why they are at high risk and works to alleviate these barriers.

Reasons for Readmittance (not all-inclusive)

  • Inability to afford medications
  • Inability to understand discharge instructions
  • Poor living conditions
  • Transportation issues
  • Family stressors
  • Poverty in general
  • Noncompliance

Working Environment

Case Management (CM) usually takes place in an office setting and work hours are usually Monday-Friday dayshift hours. CMs may wear street clothes or scrubs. In larger facilities, CM is a full-time position while in smaller facilities, you might only be employed part-time. Most CMs do not perform bedside care of the patient although they may interact with the patient.

Qualities

Experience in a variety of nursing settings

This is needed as the CM often covers several units. Few patients have only one problem when they are admitted so it is necessary for the CM to have varied experiences in order to correctly figure in co-morbidities.

Detail-oriented

The CM will be inputting information on a computer or tablet in order to determine length of stay. It is also a plus to be able to determine the nuances of a particular diagnosis. For instance, end-stage renal disease (in the US) is usually caused by hypertension or diabetes. The CM will be looking for these diagnoses and associated co-morbidities such as (for example) neuropathy, retinopathy, and cardiac disease.

Compassionate

The CM has to be able to develop a rapport with many types of people from the attending physician, to the social worker, dietician, bedside nurse, patient, and family.

Knowledgeable

  • Familiar and working knowledge using InterQual or the system used at your facility in order to assess length of stay.
  • Works using vast community resources
  • Works with social programs including local, regional, and national rules and regulations regarding eligibility.

Education

Nursing Case Managers are Registered Nurses with at least an associate's degree in nursing (ASN/ADN). Most will hold a bachelor's degree in nursing (BSN) or a master's in nursing (MSN). Some are MSN-prepared Advanced Practice Nurses such as Nurse Practitioners or Clinical Nurse Specialists. The RN must possess a current, unencumbered RN license in the U.S. state of practice.

Certification

American Nurses Credentialing Center

  • Credential: RN-BC (Nursing Case Management Certification)
  • Eligibility (2020)
  • Current, active, unencumbered RN license in U.S. or territory of the U.S. or hold the professional, legally recognized equivalent in another country
  • 2 years full-time as an RN
  • Minimum 2,000 hours clinical practice in nursing case management within the last 3 years
  • Completed 30 hours of continuing education in nursing case management within the last 3 years

Commission for Case Manager Certification (CCMC)

  • Credential: CCM®
  • Eligibility (2020)
  • Current, active, unencumbered RN license in U.S. (BSN not required)
  • 12 months full-time Case Management experience - (supervised by a CCM), OR
  • 24 Months Full-Time Case Management Experience (supervisor not required CCM), OR
  • 12 Months Full-Time Supervisory Experience (acts as supervisor of case managers)

Salary (2020)

According to salary.com, the average Case Manager salary in the U.S. is $80,497 with a range between $73,574 and $88,174.

14-yr RN experience, ER, ICU, pre-hospital RN, 12+ years experience Nephrology APRN.

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38 Comment(s)

Hello, so I was just offered a job as a case manager. And wanted to here some feed back of your daily routine as a case manager? This position will be working with HMO's?

Hello mjennLVN85,

How is your case management job going? How long have you been doing the job?

infinityRN_BSN

Has 7 years experience.

Hi allnurses!

I know I can always count on coming on this great platform to get some advice. I'm at a crossroads, need opinions on which job offer to take. I'm also currently in a FNP program. I have been a nurse for 7 years, did everything from nursing home, sub acute rehab, and now med surg (which is the cause of my burnout, and not wanting to do bedside nursing).

Job offers:

1. well known NYC hospital working night shift 12 hours (haven't worked nights in over 6 years). tuition reimbursed through previous employer by putting in hours there

2. case management job at a MLTC company. monday-friday, no weekends no holidays. no tuition reimbursement until a year later, can't put in hours at my previous job

Please help! as I need to make a decision very soon! Thank you =)

KSGMaine, ASN

Specializes in Endoscopy/Infusion. Has 8 years experience.

Hello!

I was recently hired at an insurance agency/Third Party Administrator as an RN Case Manager for Workers Comp Claims - Telephonic Case Management.

Anyone out there doing this? I would like to learn all I can - any good online courses, books, etc. or tips from any one there doing this.

Thanks!

Do you love hospice case management? Would you take less money from stressful position for hospice case management? Do this offer family work life balance?

I have been a field w/c nurse case manager for over 17 years. There are some basic things that will make your job easier and make you a success. First, always remember that when it comes to managing workers' comp claims, time is literally money. Even if the injured worker (IW) is able to continue working full time, the longer a claim is open, the more it impacts an employer's/insured's experience mod, which determines the premium. So, get things done timely. Don't let them pile up or you'll never dig out. Also, remember that everyone you speak to at a provider's office essentially has the power to make or break your getting what you need. I sometimes hear cm's saying how they told off a doctor office staff member and I always think how stupid that is. Always respond professionally. One of my hints is when you need something sent to you, explain that you want to know when to follow up if you don't get the document, so you don't call too soon and bother unnecessarily. Respect equals response -- but not always with the first request. Good luck.

pmabraham, BSN, RN

Specializes in Hospice, Palliative Care. Has 3 years experience.

Hello:

1) Absolutely

2) Hmmm, I moved up from the hospital to Hospice (not backward)

3) Work-life balance comes and goes based on the census and staffing; still, see #1

rrrnurse said:
Do you love hospice case management? Would you take less money from stressful position for hospice case management? Do this offer family work life balance?

I did hospice case management and now work in a hospital setting again. The stress level was not lower to be honest. The case load was always higher than what they told me when I interviewed for the job, they always expected me to see more pat per 8 h shift, I was driving a lot and out miles on my care and the documentation part was horrific. Also, my whole car trunk was full of hospice and home nursing supplies since you have to be on call for hospice and need to have all kind of stuff available from foley insertion kits to bedpans to pleurx drain kits and phlebotomy ... don't forget an extra folder for death certificates - nothing more annoying than arriving at a house at night to pronounce and not have a form in the car....

The per hour pay was less compared to hospital, the number of vacation days was much more and I liked community nursing. I did not like the constant expectation of taking on more pat or overtime - it did not add to my quality of life.

Hello I'm starting a new job as a field case manager. I'm confused at what the job entails. They told me I would have a certain amount of patients. I would do admits/oasis, discharges, recerts. I've never had a job in CM. I've only done PDN and the CM would come out and see the patient and assess. They said I would have an LPN also so she could come out and see patients also. I've been combing the forums but I'm not really coming up with answers. What is day to day like? Am I getting CM responsibilities while also going to see patients or am I doing only CM duties?

It sounds like you should talk to your employer about clarifying your role and what is expected of you. Do not be afraid to do this, but unless someone has worked for the same agency/state government as a CM no one will be able to truly answer your questions. A clear job description and explanation of your duties is a smart thing to get directly from the horse's mouth so to speak. I've personally never known a CM to do anything other than biannual assessments, POC and be responsible for ensuring the medical team for the patient is paid appropriately within the allowed budget.

iheartnursing91, BSN

Has 4 years experience.

Hey guys

I've been a nurse for about 2.5 years now. I'm currently working in a very busy ED in NY. I had the pleasure of meeting a CM who tells me about an open position for CM at our hospital. I'm really tempted to pursue this. Im seriously burned out from ED, and I've worked the floors before the ED but I'm just burned out and this sounds like a good opportunity. Does anyone know anything about CM? What's the job like? What do you do? For those of you who are case managers, do you like it? Why or why not?