For starters, I currently work as a case management nurse for a major insurance company that most of the dear readers have probably heard of. In fact, my employer might even be the same company that insures you and/or your loved ones. The realm of case management is very new to me; in addition, this is my very first nursing position away from the bedside. Prior to securing this position, I had been a bedside nurse for approximately 10 years in specialties such as long term care and acute rehabilitation. So far I have been working in this non-bedside role for a handful of months. The learning curve has been considerably steep, but I am learning along the way.
I work from a home office and must visit healthcare facilities to interview patients who are insured by the company that I work for. The purpose of these interviews is to ascertain whether these patients have any unmet needs that could possibly be funded by the insurance company, such as potential home modifications, dental care, vaccinations, or behavioral health treatments. If any unmet needs are identified, I must either assist in coordinating the services or make referrals to the appropriate insurance department to ensure the patient receives what they need. Furthermore, I must be on the lookout for costly trends such as revolving-door hospitalizations, frequent ER visits, unstable body weights, lack of a primary care provider, and a history of noncompliance with medications and treatments.
In a nutshell, my role involves the coordination of services that will help insured persons to maintain or enhance their health. Here is a snapshot of a typical work day for me.
8:00 to 9:00 am:
During the first hour of the day I log onto the company computer, check emails, and see whether any new candidates have been referred to me. If any new candidates have been referred, I look the patient up to find out his/her location and the type of evaluation that needs to be completed (if any).
9:00 to 10:00 am:
Most of the facilities to which I've been assigned are located anywhere from 45 minutes to one hour from my home one way. Hence, I typically spend the second hour of my day driving to a particular facility. As a personal rule of thumb, I generally do not visit multiple health care facilities on the same day.
10:00 to 11:00 am:
The late morning is normally spent reviewing the medical records of the patients that I plan to assess that day. I'm examining their diagnoses, medical history, medications, weight trends, physician consultations, social worker notes, and anything that will help paint a clearer picture of the situation at hand.
11:00 am to 1:00 pm:
The middle of my work day is spent conducting interviews with inpatients to gather data for my assessments. As previously stated, the purpose of these encounters is to figure out whether any unmet needs exist and pinpoint any costly trends that could be corrected. I typically interview three to four patients per day. Each interview takes anywhere from 30 to 40 minutes to complete.
1:00 to 2:00 pm:
This is my lunch hour. I normally spend it in the car driving from the facility back to the city where I live.
2:00 to 5:00 pm:
The last part of the work day is spent typing and uploading assessments, evaluations, care plans, revisions to the plan of care, and more paperwork into the company computer. Sometimes I do this from the home office. On many occasions I do this from a place with a fast WiFi connection such as the public library, Starbucks, or Panera Bread Cafe, especially if the weather is pleasant.
Overall, this position has been remarkably flexible. I can start my work day earlier or later if needed. Also, I can do more patient interviews and evaluations on a certain work day to catch up if I have fallen behind. My case load consists of about 150 patients and I am expected to see about 15 patients each week.
