Desire to move from school nursing into case management

[lschulz]

Hi

After working in school nursing for almost 20 years, I have an interest in the area of case management. How would you suggest that I best prepare?

[Avill, BSN, RN]

Noooooo don't leave us!!!!!

I kid. I actually have my second interview with Humana on Thursday for a PRN/casual position as a case manager. So we shall see how it goes!

[lschulz]

I do enjoy the interaction with the students and my peers. I have a lengthy commute, however.

[Avill, BSN, RN]

I'm sorry to hear that. Hope it works out for you!

[Neats, BSN]

So I am a Case Manager (CM), taking my certification test this December.

To get into Case Management with an insurance company you have to generally have your BSN (to take the CM certification it is required to have BSN)

You have to have at least 1000 (or more) hours working in a CM capacity.

You can be in case management or utilization review.

There are insurance companies out there that may hire you if you have an ADN, my company is one of them. We look at your qualifications and if you will be a good fit to our company.

What CM insurance positions are looking for is medical records review, Quality control in those reviews, and if you have ever worked with McKesson (Interqual) or Milliman guidelines. These computer programs are a set of healthcare standards that when a CM reviews the documentation you compare that documentation to the healthcare standards. It seems straightforward but there are so many gray areas you really have to know and have strong assessment skills.

Hospital CM is very different, than say home health or insurance CM's.

I would google the top 4 insurance companies, and apply. There are Third Party Payer's that provide case management as well.

[KelRN215, BSN, RN]

What kind of case management?