Does this sound like case management to you?

virgo,student nurse, CNA · Dec 1, 2012

Joe, I think you should do, what ever makes you happy. I personally don't know what the "official" job description is. Sometimes people have nothing else better to do, than complain/ or try to discourage others. I think you will be fine.Good Luck,Virgo

SummerGarden, BSN, MSN, RN · Dec 2, 2012

I've been doing CM for an insurance company for a couple of months, handling Medicaid. Things are kind of crazy, but I like it much better than floor nursing.
But my co-workers tell me what we're doing really isn't true case management. I believe the phrase they use is "glorified customer service". Perhaps that's why our turnover has been so high, more than 40% since I started. They say we should be spending more time talking to members about health issues.
I'm curious to know if this is true, because I like what I do, I like coordinating providers and solving problems and finding resources. Even though according to my co-workers this isn't really what case management is supposed to be. And I'd like to keep doing it. But I don't want to take another CM position and find out that it's radically different from what I've been doing.

To decipher if what you are doing is Case Management, look at the official definition of case management. The Commission for Case Manager Certification defines Case Management as "... a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluated the options and services required to meet an individual's health needs. It uses communication and available resources to promote quality, cost-effective outcomes."

By the way, as the other poster pointed out, you are happy working there and performing your tasks. So, who cares what your co-workers think or if you may not be actually performing Case Management? You should do fine, especially if others come and go while you remain. Who knows? You may be in for a promotion sooner rather than later. Good luck!

Reference

Commission for Case Manager Certification. Code for Professional Conduct for Case Managers: with Standards, Rules, Procedures, and PEnaalties. Accessed 12/01/2012.

Joe NightingMale, MSN, RN · Dec 2, 2012

To decipher if what you are doing is Case Management, look at the official definition of case management. The Commission for Case Manager Certification defines Case Management as "... a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluated the options and services required to meet an individual's health needs. It uses communication and available resources to promote quality, cost-effective outcomes."

By that definition, I guess I am doing CM. I think my co-workers are expecting to spend more time with members, doing assessments and setting goals. What we're actually doing is a lot of medication/specialist prior authorizations and finding providers/facilities and that sort of thing.

The reason I asked this question is that I'd like to stay in this field, but do something that deals less with members and focuses more on finding information and solving problems. So I wanted to make sure I had a good idea of what CM was.

paradiseboundRN · Dec 4, 2012

The job of case management varies a lot. It really depends on who is employing you; medical insurance company, auto insurance company, home health care, rehabilitation company, workers comp, etc. Each employer has a different job description but still uses the term case management. I've heard that's why the CCM exam if so difficult because it covers so many different areas. It sounds like you are doing case management, just not the same as your co-workers are accustomed to. If you enjoy it, great! Don't let your co-workers feed you with negativity!

jkesler · Jan 2, 2013

There is a fine line between case manager and care manager. A case manager actively works to acheive optimal wellness outcomes for the client while being a good steward of the resources available to them. This role often looks like a chinese acrobat on a high wire juggling plates. If you let one of the plates fall you lose the game. :blackeye:

OTOH it doesn't matter what the definition is as long as you are enjoying the job, your boss is happy, the clients are happy, and the company is happy.