Updated: Jul 22
Published Mar 19, 2010
What experience is needed for an LVN to work as a case manager?
txspadequeenRN, BSN, RN
i'm trying to figure out how a rn gets into case management. all the openings i have seen are for nurses that are certified....is there a course that one can take or do you just fall into these type jobs...
I work with case managers all day long. 99% of them are RN, BSN's. Several have Master's degrees. All are certified, although I'm not sure where they got their certifications from. I know there are several certifying agencies, maybe do a Google search. I know of ONE LPN case manager and according to her, she kind of fell into the job.
re: fell into the job...
I know! I met one once, and that's what she says, it just fell in her lap...
thanks for info!!
If I find out on my own, I will post it...somehow.....:redbeathe
Ginger's Mom, MSN, RN
Insurance companies are a path to case management, most have an extensive training program.
Case Management Certificate
According to my cm teacher ,you need to be accountable,a licence that says so like rn rt pt social worker
hello all! i'm new to this site. i found you while i was doing a search for an answer re: interqual, when i saw this question.
i've been an lvn in texas nearly 30 years and have been in the case mgt. arena for over 12 of those. i started out as a dc/dme coordinator in a home health office and worked my way thru the cm/um maze as a utilization management/discharge planner for a medical management company who, at the time specifically advertised and recruited for lvn's. i then became an onsite reviewer for 5 hospitals, all within a few miles of each other, for a medicare replacement hmo. one of the hospitals i was where i was onsite recruited and hired me for their first 'employed' medical appeals nurse. they recruited me because i was constantly assisting their cm's on the various units w/what items to look for to make the day(s) meet criteria to avoid denials. i also helped explain the appeal process, so if i had no choice but to issue a denial, they had the best opportunity to appeal and win. i will always be a patient advocate first, as well as for those who provide the care and i always hated to see patients/hospitals be denied, because 'criteria' wasn't always clear.
i've been at my present job at one of the largest hospitals in the texas medical center since 2001. i am the only medical appeals nurse for our 900+ bed hospital. when i was hired in 2001, i replaced 2 contract employees, (rn's) who simply appealed everything without even reviewing the record. they just sent the medical record along with (identical) form letters to all the different payors. i was able to bring this dept from a 6% overturn rate to an 87% overturn rate by my 2nd year. the first year was spent recovering from the horrendous flooding our hospital suffered from tropical storm allison. but by year 2, i had the appeals component of our case mgt dept. "in the black". in 2009, my overturn rate was 95%, and was over $6 million dollars.
i've since developed for the um/cm nurses who are on the units interqual 'cheat sheets' re: inpt vs obs, admit criteria, criteria form sheets to send to payors, etc. i've also used 'example cases' in the training of these cm/um's to test their basic skills in both cm/um. all of these cheat sheets, forms and examples, have been utilized in training any of our new cm/um's, as well as refreshers when the criteria changes, or we have a um trained nurse, go into the cm portion of the job. i've just begun developing the same 'cheat sheets' for milliman.
i only say all the above, because yes, you can be an lvn and also be an integral part of the case mgt team. in our dept. of 95+ case mngrs. and social workers, we have 4 lvn's. myself, one is the hospital precert nurse, another provides retro reviews/precerts to payors when a pt has already been dc'd. the last lvn works with our medicaid/medicare denials and other issues. she also 'floats' to the units to assist w/um duties when the units are short staffed. all 4 of us are crossed trained in at least 2 or 3 of the other's jobs, so we can 'cover' when one or more of us is out. mine is the only position that is not crossed trained to anyone else.
i love my job immensely. i enjoy 'winning' over big insurance and it's always a high when i can take their 'iron clad' denial and get it overturned. it's been a wonderful experience and i fully intend to be here until i retire or they kick me out!
I became a Case Manager in a smaller hospital while an LPN. I also went on to work at 3 seperate insurance companies as an LPN. I applied for positions that required an RN Licensure, but allowed my experience to speak for itself. I am now an RN and have been promoted to Regional Inpatient Manager with 16 direct reports for a Medicare HMO. There are many different CM certification classes out there, you will just need to clarify what specifically is the position requiring.
Be proactive, talk to your facility Case Managers and ask them how they got started. Inquire if you can shadow them on your day off so that you can learn more about the job. It is easier to get into a weekend or part time position at a hospital than full time.
UC San Diego Extension offers a $1200 CCM certification course. It's only one week long. I'm starting LVN school this summer, and will definitely be taking the CCM cert. course afterward.
I do have a question though - I've heard that case managers that work for insurance companies are sometimes able to work from home. What do you know about this? I have baby fever on the brain..I do apologize. ;-)
LPN's can definetly do case management/auditing/appeals/discharge planning/intake. I am an LPN and have been in Case Management/MUH for over 10 years. We currently do not have any RN's on staff where I work, all LPN's.
Interesting. I will definitely keep this in mind as I move through my LVN program. Part of me is TERRIFIED that I won't actually like the down-and-dirty part of nursing, as much as I would like patient education, research, ect. My ultimate goal is still to become a diabetic nurse educator. Here's hoping....:)
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