Help...QUICK! I need Case Management interview advice

[dare2believe12]

Hello Everyone, I am new to allnurses.com and I am looking for some advice. I have only been a nurse for a year and a half and I have worked as an RN floor nurse in LTC for a year and a half. I started out on night shift in a lockdown behavior/dementia unit w anywhere from 35-40 residents by myself w/in 6 months I was pulled out to be a night shift supervisor for the facility, I want to say its because they thought highly of my nursing skills, however even though I am sure trust played a roll in me getting the position I also know its because I was the only RN on nights and they wanted an RN in the position for IV Picc lines etc. I have since moved on to a different nursing home bc I was offered a day shift position in a Rehab unit. I have learned ALOT in a year and a half, even more so now in the rehab unit for the last 4months d/t a NP who is all about educating us, its awesome however, I HATE LTC floor nursing, if it weren't for all the RED tape and ALWAYS being short handed I would love my rehab hall, the residents love me bc I don't throw pills at them and run, I listen to them, the NP loves me bc I care and communicate and work hard but I am tired of working short handed and my 12hr shifts turning into 14-15hr shifts. I applied for a LTC CM position and already went through one interview. They loved me bc I have office experience, can multi task, know the importance of deadlines and of course I am all about team work and I am very friendly, however with only a year and a half of nursing under my belt they are worried about my lack of clinical experience but still have called me back for a second interview. I would mostly be dealing with insurance companies and the D.O.N. and needing to gain her trust in accepting the proper admission cases. My second interview will be with her and the External marketing Director. Can anyone please give me advice. I really want a chance at this job, I think I will love it but I am nervous about my lack of clinical experience. I am motivated and can do anything I am trained to do but what kind of clinical questions can I expect the D.O.N to ask me in regards to admissions, acceptance or not! etc! Thanks

[nurseprnRN, BSN, RN]

Case management does assume a decent clinical background, but there's no reason you can't keep learning while you also learn about case management.

Ask them what resources will be available to you to do that; will they have you work under a CCM nurse and sponsor you to take the CCM certification exam in 2 years, for example.

Will they have you spend some time to orient to the various insurance plans for seniors?-- every HMO has them. Will they send you to a class to learn the classification system they use-- Milliman or Interqual (look these up so you understand what they are and what they are for)?

Are you able to study to learn what the criteria for admission are as related to what insurance will pay for, and for how long? And for admission to the facilities/home care that the patients will go to when they leave you? That placement function will be a big part of your job. Who will orient you and teach you those ropes?

Even if you don't know a lot of this now, knowing that you are aware of these things will be reassuring to the interviewer. They don't expect you to know it all yet, but by letting them know you are at least aware of them you are communicating your interest to jump into the position.

Finally, join CMSA and hook on to your local/regional chapter. You will have a lot of questions that your peers will be able to help with, and they will give you networking and educational offerings.

Good luck!

[dare2believe12]

Thank you so much for the information, I believe it will be very helpful. I have been doing as much research as possible and I hope the facility will give me the chance to prove myself. Working the floor can become overwhelming and I believe blinds individuals to the bigger picture, continuity of care, making sure admission criteria is met, insurance requirements, etc etc. There are always going to be mistakes, we are all human, but if as much as possible is addressed and caught prior to admission it will be financially beneficial to all involved and everything comes full circle. If a facility is losing money on admits and discharges they can not profit enough to staff or supply their facility, if a resident or family is unhappy with the facility well then word of mouth can do damage and ruin a facilities reputation, it really is all about teamwork and everyone working together to make sure everyones needs are met, it can be a vicious cycle or a pleasant cycle! Wish me luck, my interview is today! Thanks again for your advice!

[nurseprnRN, BSN, RN]

Let us know how it goes!