New to Case Management

[msvarietynurse]

To all of the experienced case managers-how do you do it? I have been in case management 1 month and I can't seem to get "my flow" right. I mean everything seems important or urgent to look at first thing in the morning-from checking the emails, the alerts, medicare 1-2 day stays, Medicare's important message issuance, new admits-are they obs or inpatient and avoid having a Code 44. Has anybody found a faster and easier way to determine if a admit is an inpatient or obs admit or procedure? Is there a simpler way to determine drg and reading interqual? What resources are out there for new case managers? I know that I have coworkers but everybody seems so busy. I am still trying to figure out the best way to ask doctors when they will be discharging a patient b/c administration says they have been there too long and there breathing down my neck. I have heard the "they are not meeting the criteria to stay here so I need for you to document something that would explain why they are still here".It just seems like a way to upset the doctors and to get them to hate to see you coming. I know that it is part of the job but I would like to know of some forums or resources available to help a new case manager progress in this role. Thanks in advance for any responses.

[rnccm, RN]

It takes several months to find your flow, just like it did when you were a new nurse with that very first job. Case managment is a totally different mind-set. I understand your concern about the doc's "hating" you, but really, you have to ask those questions, and at times push a little if a doc is slow with his patient's discharge or lacking in his documentation. That is why the hospital hired you... not to be friends with the docs or the most popular case manager. Our facility uses Milliman only and is very easy for the new case managers to pick it up. Interqual does take a little longer, but after you've done this for a while, you'll be able to quote the criteria from heart. Work smart, not hard. Identify what is slowing you down, are you talking on the phone too long, are you handling the papers two or three or more times, etc. Funny isn't it, case management looks so great to other nurses, they think all we do is talk and flip through charts! Join your local CMSA and attend the monthly meetings. They are a great resource.

[adlockwood]

I would suggest you talk to your supervisor more - it sounds like your orientation was not enough to make you feel comfortable with proritizing your work. I am also new to hospital cm, having only been there a week, but I have a very good feeling that I will be given adequate orientation to understand the flow and priorities before they throw me to the wolves. You deserve a good solid start, so you become the best CM you can be. You will be slow in the beginning, but you should have a good idea of what to do first.

[mshreffler RN]

I have been doing CM for about a 1 1/5 yrs and really love it. I can see how you would get the feeling that the doc's will "hate" you. But trust me your not the first CM that they have talked to. The feelings that your having is because its a new job. Just like when you were a new grad and had to call a doctor for the first few times...you got over those jitters and you will get over these "new worrys" trust. Good luck and enjoy! Remember its a team approach..everyone is trying to make sure that the patient is getting the best care without keeping them in the hospital exposing them to "new and exciting germs"!