How to break into case management nursing and utilization review....

  1. I have roughly 4 years of clinical nursing experience, with some indirect case management, insurance verification and discharge experience. I applied and interviewed for a job which said ,"ENTRY LEVEL CASE MANAGEMENT" but upon arriving they said they would prefer that I had some case management experience.

    1)I'm so confused about this, but that's a different story entirely.
    2) How do I break into case management?
    3) How do I break into utilization review?
    4) Is there some place on the internet, perhaps even on this forum, that gives a good run down of UR and CM, such as steps involved and what not?

    I appreciate any and all help you can give me!
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    Joined: Sep '08; Posts: 40; Likes: 11


  3. by   NickiLaughs
    This isn't a very active forum I've noticed. From what I've seen, it seems like you almost have to know someone or be working somewhere that will let you switch to a case management position and train you. It's not very easy to break into.
  4. by   nursingosaurus
    Thank you for your insight, and I have noticed the same thing. Can't give up though!!!!
  5. by   SummerGarden
    Quote from NickiLaughs
    From what I've seen, it seems like you almost have to know someone or be working somewhere that will let you switch to a case management position and train you.
    This is how I did it!!! I switched using connections in the hospital where I worked as a Staff RN. I ended up taking a cut in pay to do it but it was worth every cent! Now I have CM work experience and I had no trouble getting another better paying CM job and I am in the process of landing a good paying Per Diem CM job to boot! Good Luck!
  6. by   judywag
    Hi there , from what i have heard , you should look up all medical insurance companies ex: united.Frequently i see them advertise for will train then can telecommute and they appear to offer good packages. Hope that helps,
  7. by   nurseprnRN
    check out the case management society of america (cmsa) and hook up with your local chapter. if you are anywhere near san francisco, that's where this year's annual conference is-- see if you can go, june 19-22, moscone center. the website will tell you about how to become a member and where next year's conference is. do plan to go to that one. check out the requirements to become certified in case mgmt (ccm) and start working on it.

    one of the best things to do for yourself as a beginning cm is to get some good mentoring. i was fortunate to have wonderful ones when i was starting out. you will also hear of job openings before they're posted and make some friends who can recommend you as a newbie. dress like a professional-- business or business casual. you'll be dealing with people who are more business than medicine-- culture change!

    you do not have to be an in-house cm-- as a matter of fact, i recommend starting elsewhere. i had been a critical care specialist when i began in work comp cm and knew just about nothing about it; i learned to love occ med. they hire you for your brains, your ability to read medical stuff and understand it, your ability to work independently and to be comfortable seeking new ways to learn, and they'll teach you the ropes as you go.

    i was devastated to lose my critical care clin spec job in a reorg, but in retrospect it was the best thing that ever happened to me. it got me where i am today.
  8. by   emilysmom,RN
    I am a RN case manager for a home health company. I also do home care visits.
  9. by   Are-En-Fla
    I would eventually like to get into case management as well. I am finding that working on the floor, when seeing the case managers, I let them know what is going on with my patients. They seem to like that I have interest in what they are doing and seek me out now instead of me seeking them out. I was even offered a part time position but I don't want to take it right now since I am not even through with my 6 month orientation period! I feel that I need more patient care experience to tackle this stressful position. So, I would have to say that it is probably true that you have to shmooze with the case managers on your floor to get your foot in.
  10. by   BahaMamamaRN
    Lol at your reference to "schmoozing the case managers on the floor" laughing but good advice for those seeking a position. I find everyone we have hired are from CM recommending floor nurses or other known experienced case managers who knows someone experienced or not. Good luck in your search.
  11. by   MArdt1
    I know Wellcare in Tampa is hiring Telephonic Case Managers, if they don't have Case Mgmt exp, an ICU background will do. 9-6 Shift, Competitive Salary, and manageable work load. You should check out their website. Hope this helps! Have a wonderful Day! ~ Melissa
  12. by   Missy71940
    It is hard isn't it. I have worked for 8 years as a medsurg/relief supervisor/icu nurse. I am from a small hospital I am fortunate to have experience with pediatrics, postpartum, gyno, ortho, surgical, and typical med surg patients. I recently applied for a beginning case management job within my company and was not even granted an interview. I got a kiss off letter telling me how unqualified I was. LOL
    Good luck. I hope you get a foot in the door somewhere.

  13. by   SummerGarden
    Missy, did you actually talk to the Director of Case Management within your company prior to applying for the position? If not, that is probably where you went wrong. It is possible that the position to which you submitted your application had a specific nurse in mind as oppose to being a real position for anyone to apply. Currently that is what is going on where I work. A position is posted and only two nurses are being considered for the position despite others on the outside submitting applications.

    Thus, talk to the hiring manager and let him/her know of your interest to change your Nursing specialty to Case Management. Also, be sure to ask him/her the best way you can improve your resume for future consideration within an entry-level position. Who knows? The next time there is an opening for an entry-level Case Manager within your facility, you may be the nurse the hiring manager has in mind. Good Luck.
  14. by   queen mother
    Hello everyone, just wanted to say thanks for all your responses. I am an IMCU nurse for well over 7 years with a BSN and have been having a difficult time trying to even get an interview for a case management position. I also get the kiss-off responses that the went with another candidate. I thought There was something wrong with me. Didn't imagine it would be this hard. Your coments have given me hope to not give up. I am in the West Palm Beach FL area- appreciate any advice.
    queen mother