Question about Case Managers

[hoolahan, ASN, RN]

HI guys. Not sure if this should go in case management forum, but I need to address a broad span of nursing, in many specialties.

I am a case manager for a Workers comp managed care co, and I am presently dealing with a "case manager" in a subacute rehab center, who is not credentialed in anything.

I asked, for my report, if he was a RN or MSW, and he said, "Well, actually, I am new to this position, and I am not a nurse or soicial worker. MY DON assists me with the clinical information."

Huh?? WTF? Is this what is happening in your facility? Can anyone now be a CM as long as they have a HS ed? What is up with that?

Is this legitimate? I mean, shouldn't this facility be utilizing a CM who knows something about a person's clinical needs? What type of agency should I check this with? State health dept? BON?

Anyone else using case managers who are not nurses or social workers?

[sjoe]

Why do they need to be high school graduates?

[kids]

Yes Hoolahan...I would be b***hing to someone, I have no clue who tho. How can you base need for services or approve/decline services if you are getting the info from someone who has no idea of even the basics.

[CseMgr1, ASN, RN]

You can't, Kids-R-Fun. I deal with facilities every day, who have discharge planners who don't know the difference between skilled and custodial care. They get very upset (and sometimes downright nasty), becuase they are counting on the skilled facilities to take care of Aunt Jane, whose family can't (or won't) take care of her, and her inpatient coverge is up, and there's no place to put her.

[renerian, BSN, RN]

I have never heard of that hoolahan.........???

renerian

[LasVegasRN]

Sometimes they have an LPN or CNA give the clinical information, but it should be SOME type of licensed person. If it's not, then I tell them our company policy REQUIRES report from a nurse. If they can't accomodate the request, then I tell them to transfer me to the nurse who was assigned to that person OR the floor charge nurse. If they still have a problem, I ask for the DON.

They should know better.

[hoolahan, ASN, RN]

I thought it should be a licensed person too. We have LPN's case manage with us, and MSW's BSW's, Vo-Tech counselors, but there is always some kind of credential!

The pt's wife just told me she spoke to the "social worker", so either she or I misunderstood what was said, OR this guy is not correcting that assumption. The wife may have simply thought this b/c she knew the CM at the acute facility was a MSW. If he is allowing people to think he is a MSW, that is fraud isn't it?

Anyway, he's on vacation this week, think I'll chat w the DON on the pretense of needing info, and ask her for his credentials for my report. I'm not turning anyone in, at least until I know there is something fishy, but I think I'll call JACHO too, just to see if there are regs for UR/CM in a rehab facilty. I'll let you know what I find out. Probably won't get to it til Friday though.Thanks for your input!