How do LVN's train to become Case Managers?

What experience is needed for an LVN to work as a case manager?

I'm a new grad and Im been train to be a case manager! Tomorrow is gonna be my first day by myself. !!!

I've been an LVN Case Manager for going on 3 Year's in California, I work in a SNF and see a lot of LVN CM's in LOng term care, HMO companies, and home health offices. My company requires all CM's to have a social services designee certification which takes a few days to obtain, and at least 2 years clinical experience.

As as far as what my job expectations are, I have to balance the financial and clinical side of a patient's stay, only with HMO patients. i make sure we provide all the contractual minutes for rehab, find alternatives to costly medications and treatments, generate a cost sheet for each patient to see if profit/loss is made, do weekly progress reviews with HMO's and doctors, coordinate DME/Home Health and follow up appointments for discharge planning, and acquire authorizations for inpatient stay, DME, home health, and specialty appts.

Occasionally, I'll attend careplan meetings if the family or patients have questions that pertain to insurance,

its very difficult to find 1 on 1 time with the patient, I try to get at least 10-15 mins with

my patients weekly to make sure they're still participating in therapy, the IV lines are discontinued when they need to be, and that all the PCP, family training and pharmacy information is coordinated and correct.

Lastly, I also, on a monthly basis meet with business office to make sure all patients Had authorizations to stay so we can bill appropriately for the correct level. I have to familiarize myself with each insurance and how much they pay for each level of care. Sometimes they'll only want to pay for a level of rehab, when the patients have IV's and that can pay up to $150/per day more.

It requires a lot of time management skills, organizational skills, and it can be very exhausting. It's a lot of trouble shooting, coordination, and some days I rejected a lot for auths and exclusions. Some places don't require as much from LVN CM's, but I love what I do. When I want to relax, I ask to go on the floor and pass meds. That's soO much easier

hope this helps

Hi i just wanted to know if anyone knows in LA the starting rate for case manager...im an LVN subacute and im planning to take healthcare manager which falls under different titles. I been checking the pay and it varies. Pls give me some insight thanks.

Specializes in Med Surg, Tele, PH, CM.
On 4/10/2012 at 7:08 PM, BeanTrees said:

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. ?

Most employers will not allow you to work from home if you have a child at home. They expect you to devote the entire day to your work, so you wouldn't have time to take care of a baby or toddler.

I got placed in that type of position a long with visiting patients in their homes (under NPs and MDs) with the HMO/Company I worked for(I did blood draws, vitals, assessments, and etc in pt homes). Had to learn about Medicare, Medicaid, private pay, discharge planning in our hospitals, what made pts meet skilled care criterias, DME, medication costs, and all that jazz. It was cool for 10 years.Worked with cool case managers(one of them hired me as a CNA before transitioning to case manager decades ago with the same HMO), NPs, managers, LVNs, RNs, lab techs, and other crazy folks ? in our office / hospitals.

I'm a LVN in Ca and a case manager. I was a floor nurse at a SNF, and I was promoted. When our old case manager left, my DON said she thought I would be great because of the way I interacted with residents and families. I had no idea about insurances or how the process worked, but it's been so great!

https://ccmcertification.org/sites/ccmc/files/docs/2022/CCMC-22-Certification-Guide-Update-Final%20with%20CM%20def%20update.pdf

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