Hospital CM vs Managed Care CM pros and cons

[MsCharles]

I currently work for MCO but there has been a lot of restructing in the past year and a half and it is starting to become overwhelming. I am thinking of trying hospital cm but dont want to go from bad to worst . My co-workers with previous experience say its a lot more stressful. I was new to MC CM when I took the position and agree with others when they say it is a large learning curve but I think it would better with good orientation which I didn't have.

1. For people who are case managers and have worked in both settings can you tell me pros and cons?
   
2. Does it make a difference if hospital is in and urban setting vs. suburbs?
   

[SummerGarden, BSN, MSN, RN]

I have only worked in a Hospital setting, so hopefully others can answer your question with experience in both settings. In any case, hospital CM is not a stress free job. It is not just the learning curve (which is about 1 year plus, but orientation is not 1 year plus), it is also the fact that it is similar to bedside nursing. You must move fast and make things (discharge planning and UR) happen fast. There are barriers to discharge that you are responsible for with each of your patients and no one else. Also, you may or may not be on the same floor/unit every day. Many times you must be able to work different type of units with different nurses, doctors, etc. due to staffing.... I can go on, but reality is that the hospital setting is not organized necessarily compared to other environments and it is definitely not easier. In fact, the turnover rate is pretty high in the hospital setting. The only setting I have known with a low turnover rate for Nurse Case Managers is Public Health.

Their focus is totally different (population based rather then individual based). Some have a case load of individuals or organizations, but they do not perform UR and they have no pressure to move patients/organizations to the next setting of care with resources in place. Those nurses perform assessments and make referrals similar to the rest of us, but they implement interventions that are completely different. Which is why they do not actually call themselves Case Managers, but rather Public Health Nurses. Good luck!

[nurseprnRN, BSN, RN]

I worked as a CM for a HMO. A colleague and I shared an office with some CMs from other HMOs who came in a few days a week (we were there every day). The hospital case managers had their office next door and we hung out with them regularly. They didn't envy us the really obnoxious hospitalist we had to work with but otherwise they thought we had a much better job. I tended to agree.

[MsCharles]

Thanks that is what I thought and I can see how turnover can be high. I feel like as a CM your expected to do everything; organizations use the title so loosely it can mean so many different things nowadays.