case manager - what can you tell me about it?

[abc987]

Hi everyone,

I graduated nursing school in May 2010. I am currently working in a LTC facility (night shift). Sometimes it's okay and others i'm too overwhelmed to handle it. I was recently contacted about a case manager position at a hospice in NJ. What can you tell me about case management? What are the hours like? Can I work as a case manager as a new grad with only a few months experience? Are they usually on call times? I would prefer no on call times because it works better with my personal schedule. What goes into a typical days work as a case manager? Does it involve visiting patients in their homes? Any information is very helpful ! Thank you! :)

[abc987]

ive read other blogs about case management but none of the ones i saw where in NJ. anyone working as a case manager in central/upper NJ that can help me? whats the job satisfaction rate? is the starting salary really $70,000? i want a nursing job that allows me to have a life outside of work. i dont particularly enjoy working shifts and always waiting for the next shift to show up (which may or may not happen) and then getting stuck working doubles or even more. i feel like i have no life and i'm still in my young 20s. i need a job with more set hours. 8am-5pm, etc. where i know that at the end of my day i can go home and dont have to depend on someone else to show up after me. is case manager a good solution to this? whats the stress level? thank you so so so so muchhh!

[Ella Halligan RN]

Case managers usually are, and SHOULD BE, experienced nurses. You need to have the experience with patients enough to understand what type of services they are likely to need when they go home and what type of care they will require. Will they need oxygen? Someone to come in and cook for them? Full time live in support? Placement in a nursing home? There are so many different variables. Will they need a wheelchair? Specialized furniture?

You also need to be able to work well with insurance companies and learn how to word what your patient needs in ways that make sense to them so that they will pay for it.

I wouldn't want a new grad as a case manager for me or for anyone I care about. It is a difficult job and all of the case managers I have ever worked with are EXCELLENT at it. You need the tenacity of a pitbull and the ability to keep pushing for what your patient needs through millions of piles of forms (many online now) and you need the understanding of the medical conditions they are suffering from in order to know WHAT they need.

Get some more experience under your belt before you try to take on a case management position.

Elisabeth Halligan, RN

[abc987]

thank you Elisabeth. If you don't mind me asking, are you a case manager yourself? in what area? any more information you can give me about being a case manager? I wasn't looking for this type of position, the opportunity came to me. I applied for a position as an RN and was just contacted to be a case manager. Thank you again!

[Ella Halligan RN]

No, I don't do case management. I have, however, worked with many phenomenal case managers over the years.

I know a couple of people who did case management for hospice type positions. It is NOT easy work. You have to see a certain number of patients each day and there is a lot of driving and report writing to do. You really need to know patient care VERY well because you have to be able to advocate for your patient. If you don't know what normal is, how will you know what ISN'T normal when you only see a patient for a few minutes once or twice a week?

Generally speaking, unless you are a specialist in some area, I would worry about any employment opportunity that seeks YOU out, rather than simply just posting an opening. To me, that speaks of a place of employment that cannot keep its staff... ask yourself why not?

Elisabeth Halligan, RN

[abc987]

I understand what you mean Elisabeth. Although it is very tempting especially since i'm pretty unhappy with where I am now. I'm looking for more of a monday through friday 8-4/9-5 type of nursing job. Where I am now is so stressful I come home and cry. It's not good for my mental health, and I feel so run down. Any advice you can give me? Should I go through with the interview and/or accept the job? are there on call times?

[rn undisclosed name]

Why are you doing LTC? I am assuming you are an RN. Have you tried hospital nursing. I think you'd be happier. I am an RN and would never do LTC. I have, however, worked in LTC as a nursing assistant and that left a sour taste in my mouth for LTC. I know some people like it but it's just not for me and I could have also been at a bad facility. Now don't get me wrong it's still stressful but you're not responsible for nearly the number of patients you are in LTC and that in itself might make it a little less stressful. Plus, I think it would help you out better if you ever want to do case management in the future. I agree with Elizabeth that you definitely want to have a few years under your belt before you venture into that. Good luck!

[Ella Halligan RN]

I don't know. You'd have to ask the person you interview with. Just be wary, like I said. Remember that what is said in an interview isn't necessarily what pans out in practice! Why are they having to contact people rather than just posting an opening? Why are they offering a case management position to a new grad? What is their motivation?

I would suggest you look for a clinic based job, like a doctor's office. Some of them still use actual nurses. (The rest just call their MAs nurses and hope the public doesn't know the difference. But that is an argument for another day and thread... LOL) Or even try go to from the LTC facility (the only LTC facility I ever worked at was horrific and made me cry all the time, too) to a hospital based position. The hours wouldn't be any better, but I personally like the environment better! Good luck!

Elisabeth Halligan, RN

[enchantmentdis, BSN, RN]

You really need a good 2 years or more of solid med-surg, tele, neuro, onco background in order to be a hospice case manager. You must know all the meds to treat pain and symptoms. LTC provides you with a good background for dementia and Alzheimers (hospice is filled with dementia patients) but you need to be there much longer to embark on a hospice career. Hospice aggressively treats symptoms including nausea, vomiting, pain, dyspnea, delirium, terminal restlessness, anxiety/agitation, constipation,wounds, anorexia, edema, etc and the hospice nurse must effectively coach the family or facility staff to use the various meds to treat the symptoms to ensure patient dies a "good death". You will be working independently most of the time, mainly calling the hospice doctor to change med dosages--usually increasing them. You will have to be very confident, but gentle, especially when the family decide they want the patient to go to the hospital again. You are the one who will convince them to let the patient stay in the home and that you will help pt be more comfortable and die with dignity. All of this is more easily accomplished if you first have a stong acute care background of several years. You just know more about the various problems that can pop up and the treatments used to remedy or at least palliate them. Some hospice facilities take new nurses with one year of med-surg but they have to train them longer and they are not confident for a long time.

[CoffeeRTC, BSN, RN]

I think LTC experience (more of it for the OP) would be an okay experince for a hospice nurse.

The LTC I work at is more sub acute than just alz and dementia patients. Over half of our residents are d/ced to home within 8 weeks. Then there is the hospice type patients and everything else the PP described in her post.

For the OP...I think you would need more experience for the case worker postition.

[melloyello13]

I worked as a case manager for a homecare agency for eight months and I was a new grad. In my situation, the case managers were pretty much used to make sure documents were in order. We also ordered services like rehab, DME supplies, HHA services, handled complaints, and wrote doctors' orders for them to sign (this is just a short summed up list). I really did not use my clinical knowledge for much, which is very different from hospice or hospital case management. I do feel that you need a good understanding of patient needs to be a case manager, but it depends on the type of case management. In my situation, the visiting nurses were doing all the patient assessments and just reporting back to me so I could put everything in order and start the process. You might have to do that aspect for yourself though so that might be an issue if you don't know what to look for. On the other hand, alot of the visiting nurses were new grads themselves, so they didn't have that strong of a clinical background either. We had a separate billing department so I was not involved with insurance companies at all. I had to have a basic understanding of what insurance did and did not pay for though. My work hours were 9-5 mon-fri, no weekends, no overtime (though many case managers stayed late to complete their work with no pay), no on call. I really did not like case management because I wanted patient contact but hospital RN jobs were very difficult to come by in my area for new grads. It involves alot of paperwork and alot of time looking at a computer screen. If they're willing to offer the job to someone that doesn't have a lot of experience then you will probably be fine with it. The case coordinator at my hospital isn't even a nurse and I've been told that she's been doing a very good job.

[hhrnohio]

As a former hospice clinical director (quickly realized hospice was not for me) and current RN home care case manager i can tell you that no case manager i have ever known including myself works 8-4/9-5 hours. You will most likely be driving to your patients and probablys seeing at least 4-5 day. Most likely there will be some form of on call. However saying all of that i say GO to the INTERVIEW it doesn't hurt anything or anyone and gives you practicing interviewing in case a job at a hospital or different SNF comes available. the more practice you get at interviews even if you don't get offered the job or don't accept the job can only help you down the road with future interviews. As far as pay goes i have no idea if that is accurate (no where near that in Ohio) you need to find out if you are going to accep that if the pay is salary(paid x amount every week, hourly, per visit, etc) also if there is on-call is there pay for that or is it included in your salary? What is expected of on-call?

let me know if i can be of further assistance