Case Management Nursing (CM)

[traumaRUs]

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.

[ruby_jane, BSN, RN]

I feel like I do case management every day of my working life, and it's pretty rewarding when it works. Can you ride shotgun with one of them first to see what it's like?

I am not sure CM will help you with burnout. I also hope that the CM nurses are dedicated to that and are not pulled to cover a shift for someone who's called in sick. You won't know that until you see how the wind blows where you are. Good luck!

[Been there,done that, ASN, RN]

All you can do is apply. Know the job description and be prepared for the interview.

You will not be performing patient care, you will be coordinating the care the patient needs.

You have the experience required. Go for it!

[Lunah, MSN, RN]

I know nurses who have gone from ED to CM and enjoyed it. We ED peeps are kind of natural problem solvers after a while! Definitely consider it. Great opportunity that could even turn into a work-at-home position someday - some of the large insurance companies have a number of nurses doing telephonic CM.

[iheartnursing91, BSN]

Thanks for the responses. I do love working ED, but the stress level is too much. We are short staffed, often take on 8+ patients at a time, and once they get admitted it takes up to 2 days to get a bed on the floor so we have to care for them also. Some nights we have no charge or clerk. Management knows all of this, nothing has been done, and people are leaving for other hospitals. I've applied & going to have a phone call with the director tomorrow. Can anyone tell me what exactly a case manager does? All I know is bedside nursing. Thanks!

[Nurse_Katina, BSN, RN]

This is what I do. I spend about half of my day in the field completing the visits that you mentioned, then the other half in my office completing/correcting paperwork. I do sometimes do nursing visits too, like weekly med sets, if we are short a field nurse. It's not part of my regular duties though and I am not expected to do both their job and mine. My case load is around 30 patients.

[NurseMegP, BSN, RN]

Worker's comp is it's own beast and a LOT of providers don't understand how it works (that goes double for the office staff under them). At least that's how it is in Ohio . Just try to learn as much as you can. Read the policy. Don't be afraid to be inquisitive! I think as a UR RN in WC it's made my job easier to know what the CMs do, the billers, the claims analysts/assistants. Good luck to you! I hope you're enjoying it!

[fsudmbRN, ASN]

I am a field case manager, also. I basically do all needed OASIS visits and supervision visits. Depending on the area patient load, I do a bunch of routine visits, also. My patient load is between 60-100 patients.

[guest1074638]

You will end up with a larger case load than they tell you (I have worked for 3 hospice companies), they don't tell you about on call (which is a nightmare), and they will expand your service area to the point where you are so far away from home that you can't possibly get to patients within 30m. This is how most hospice companies are operated. They will bs you during the hiring process and then they will avalanche you with work.

[Kaisu]

I am so sorry you have had such bad experiences. It is so agency dependent. I have been working hospice for a year after home health and a short stint on med/surg.

I receive total support from my team including management. If I feel overwhelmed they will adjust my schedule. If I need backup, I got it. My review was 3 months early and I received a substantial raise. I now make 20% more for equivalent hours than when I was med/surg/telemetry.

I get paid my hourly rate for travel time and 0.47 a mile. It makes my car payment and pays for gas.

It can get very challenging, especially when multiple patients transition at the same time. The documentation is a constant challenge. It is the best job I have ever had and what I went to nursing school for.

Please don't give up on the field if that is where your heart is. Find a good agency.

[pmabraham, BSN, RN]

On 3/21/2019 at 10:31 PM, nursecranberry said:

They will bs you during the hiring process and then they will avalanche you with work.

I'm sorry for your bad experience. I've been with the same company for almost a year now, AND have not had your experience. I'm so grateful to Jesus to be a hospice RN case manager.

[ivyleaf]

If you dont want to do bedside nursing, it seems like the case management job might make more sense? Unless you want to do 12 hr shifts and/or nights..

[mhurn]

I have been a floor rn for nearly 13 years. 6 months in LTC, 7 years part time nightshift on a medsurg floor that does ortho/neuro and tele (i have cont to work there for the last 5 years as per diem) and nearly 6 years 3-11 psychiatric nursing. I do have an associate's degree and live in MA. i have been researching different avenues of nursing and feel something such as case management, chart review, utilization management or disability/insurance jobs would be something I would be interested in. How do I make a transition into that? seems all the jobs out there require previous experience. There are currently no openings at the jobs i am at nor are they going to be willing to train me anyways. Also I may be relocating to NH in near future. I just wanted to know if anyone has advice.