Case Management

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    Case Management is the nursing involved with the business of length of stay. Incorporation 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.

    Case Management

    Case management encompasses several models depending on the work environment. In the hospital, case managers are frequently utilized to determine length of stay and incorporating individual patient dynamics into the equation.

    Interqual is the resource most facilities use to determine qualifications of patients with regards to their admission length. Case Managers (CM) 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 also can encompass risk management as it relates to patient 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 nowadays.

    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. Some reasons for readmittance are:
    • Inability to afford medications
    • Inability to understand discharge instructions
    • Poor living conditions
    • Transportation issues
    • Family stressors
    • Poverty in general
    • Noncompliance

    Working Environment

    Case Management 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.


    Most CMs are RNs and most have a BSN. Experience is needed also for most CM positions. Certification is desired.


    Desirable qualities of CM RNs:
    • Experienced in variety of nursing settings. This is needed as the CM often covers several units. Few patients nowadays 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-morbids.
    • 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 nuances of a particular diagnosis. For instance, end stage renal disease (in the US) is usually caused by hypertension or diabetes. So, the CM will be looking for these diagnoses and associated co-morbids such as 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 about InterQual or whatever system is used at your facility in order to assess length of stay.
    • Knowledgeable about community resources if your job is also to refer patients to other sources of assistance. Knowledge of social programs including local, regional and national rules and regulations regarding eligibility.

    Resources has an active Case Management Nursing.

    The National Institutes of Health provides a literature search of case management and how it relates to care of a defined patient group.

    Commission for Case Management Certification is a certifying entity for CM.

    The American Nurses Credentialing Center also offers certification.
    Last edit by traumaRUs on Jun 15, '18
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