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.

[KrysyRN, BSN]

You may want to consider joining AAMCN - American Association of Managed Care Nurses - and their certification course. The certification may be helpful with landing one of the jobs you're interested in.

Another good way to find these jobs and to network is on LinkedIn. Find nurses in your area that are doing this type of work and see if the have any advice for you or know of openings. Maybe set up some informational interviews with them.

Anecdotally, my nurse friend found a chart auditing position on Craig's List of all places. She works for a major, monstrous university and travels around the state auditing charts in a car they rent for her. She had no prior experience doing this kind of work and said the pay was not good. No benefits. But she loves the job.

[Guest757854]

Best way to get into one of these positions...is to APPLY, APPLY AND APPLY. Now I know it may sound basic and simple, but trust me...as someone who is currently working as case manager with no experience, no case management certification and no affiliation with any case managedment or managed care associations...just simply applying as many time as possible, really does work. Good luck to you

[Mortaaaay]

Would people hire you without experience?

Did you need certain certifications?

[Guest757854]

I was hired into caee management without experience. I just kept applying. Then i got the call for the interview and then i was offered the job. It was hard at first adjusting to "normal" mon-fri dayshift schedule. But i did it. I did it for the past 2.5 yeras. Now im going back to bedside nursing. I just missed it and was tired of case management. It was getting boring at times but most of all i felt like i was losing my skills. I will revisit case management later on in my career but not now.

[Brwnidbeauty, BSN]

Hello!!!!

I am also new to Workers Comp CM, WAH. I am just starting my new job, previously doing WAH Disease Management which was totally different then my new job (WC). I am finding the "WC verbiage to be a really challenge for me in my documentation.

The company does not have me following any 1 nurse, or really anyone. A Team Lead checks all my documentation before I complete and save it to go into a file. I am having problems with the Nurse Analysis part and Plan of care (being assertive with my actions). I am told to view other nurses charting/docs which I do … do, but still struggle.

I am told I am doing fine... and its "normal" ….. and I am lucky to be on 1 dedicated account vs multiple accts which, YES, I am gratefully, however, still struggle as a NEW Work Comp RNCM.

How R U doing? Do you struggle with similar issues?

Stacie ?

[CardiacDork, MSN, RN]

Has anyone made the transition from ICU to Nurse to Case Manager? If so; please give me some insight. You don't have to answer the following questions, but they serve as a good template of the things I am wondering.

This is NOT a school survey; these are questions for my personal knowledge and awareness, as I want to make a diversely influenced and informed decision.

What most do you enjoy about case management?
What most do you dislike about case management?
List a few things you absolutely miss from ICU nursing:
List a few things you absolutely DO NOT miss from ICU nursing:
How would you rate the overall stress level of being a case manager from 0 to 10?
What are the largest stressors of case management?
How would describe the stress of case management in relation to/relatively to ICU bedside stress?
Would you say case management is less physically taxation than ICU nursing; why or why not?
What is your BIGGEST case manager pet peeve?
Have you considered quitting case management?
Have you considered going back to the bedside?
Do you work bedside part-time?
If you quit case management tomorrow; chances are - WHAT would be the primary driving force behind your resignation?
As a case manager, what sort of things could get you fired; as opposed to things that would get you fired as an ICU nurse?
What floor do you do case management on?
What's your highest nursing degree you hold?
How did you end up in case management; were you running from bedside? it just fell upon you? you were curious?

Share something with me that you just gotta share?

[ivyleaf]

CardiacDork, did you end up taking a CM job? I am wondering the same things...

[B52HOLYTRINITY]

CVICU nurse here with background in ED as well. Just accepted a position in Inpatient Care Coordination. Start date is 1/19/20, so I'll come back here and let ya know how it goes. Excited for something new!

[guest940422]

I started working in UM a year ago. They want strong clinical background, charge experience, and really look at extras like being certified having a BSN and committee work. I also never stopped applying for jobs... for real... like submitting applications several times a week for over a year. I started working for disaster health services at the red cross as a case manager. The training is annoying, but once that's over you do virtual case work on your phone with a computer. They don't have minimum hour requirements so you can just do it whenever you have a little time (like never more than 20 min here and there). It was the only way i could find to get experience without already having experience. my boss said that was the only reason they were willing to interview me.

[Debra Nefussy]

Renge1

kind of just falling upon this site. And saw that you were part of the first graduating class at Concord in Denver. So was I. Would love to catch up? Name?

[Linda Price]

Hello Debra, how are you? The name sounds familiar but I cannot place the face. Yes I was in the first Concorde graduating class. How did you find me? Have you been in touch with anyone else?

[ivyleaf]

On 12/13/2019 at 5:20 PM, B52HOLYTRINITY said:

CVICU nurse here with background in ED as well. Just accepted a position in Inpatient Care Coordination. Start date is 1/19/20, so I'll come back here and let ya know how it goes. Excited for something new!

B52: how is it going so far?