Job interview for hospital-based CM

[Julius Seizure]

I'm looking for advice! I have a job interview for a hospital CM job next week and I'm trying to prepare. The position is specifically for a case manager for the ICU.

I am searching for any suggestions of (1) things they will be looking for, and (2) things I should ask them.

I would love to hear anything helpful that you all could offer. Thank you :)

[SummerGarden, BSN, MSN, RN]

(1)

As a bedside nurse there are skills you can bring to a RN CM position that an employer will want to see such as understanding the model of care within the ICU if you have worked an ICU before. However, you need to be able to talk about (concrete examples) of times you can: 1.) Manage conflict between parties and between you and others 2.) Resolve problems unrelated to IV starts and basic nursing skills, 3.) Deliver bad news, 4.) Handle stressful situations within the workplace, 4.) Work at a fast pace to get things done (be organized and be able to work fast and multi-task), 5.) Talk to MDs, RNs, PCTs, etc... regarding a team approach to discharge planning, 6.) Discuss a time you were able to help with discharge planning, 7.) Show an ability to pick up technology with which you are not familiar, 8.) Show an interest in becoming dedicated to wanting to be good at this new specialty (It can take a year to be actually OK-Good at hospital case management... It is not easy).... The list is end list, but this may be a good start for you...

(2) What type of orientation will you receive? Is it didactic as well as working with a preceptor to take patients (these are the best orientations)? How long will orientation for brand new CMs receive? What are the basic expectations of a CM in the ICU? Are there resources available to provide patients and families? Are their Social Workers who perform duties in support of RN Case Managers? Are their Navigators (these are technicians who perform a lot of the clerical duties to free you up to perform more of the RN licensed duties non-RNs are not to perform because it would be considered outside of their scope of practice)?

When you start working or if you know someone already on the inside, ask the other CMs about the turnover rate and the culture of the company(Is there a lot of off-the-clock OT/ Free labor given to this company in order to keep up with the work load)?

Good luck! :)

[Julius Seizure]

Thank you so much, that was incredibly helpful! I'm keeping a positive mindset because they seemed really eager to set up an interview with me quickly, and I have the specific PICU experience that they want. Thanks for the good luck wishes!

[Been there,done that, ASN, RN]

What exactly, is the job description?

[Julius Seizure]

What exactly, is the job description?

Description:

Position Summary-Full time-Need PICU experience

The Case Manager utilizes advanced nursing skills and knowledge of resource management and fiscal responsibility to coordinate the clinical care for a designated patient population across the continuum of care. The responsibilities include but are not limited to clinical effectiveness, discharge planning, care coordination, clinical resource management and core measure documentation. The Case Manager interacts with Medical, Nursing and Ancillary staff to facilitate quality based, cost effective patient outcomes and ensure care is provided in the most appropriate setting.

Essential Duties and Responsibilities

• Requires in-depth professional knowledge and practical/applied expertise in own discipline and basic knowledge of related disciplines within the broader professional field

• Has knowledge of best practices and how own area integrates with others; demonstrates awareness of the industry, including regulatory, evolving customer demands, and the factors that differentiate the organization in the market

• Acts as a resource for colleagues with less experience; may lead projects with manageable risks and resource requirements

• Solves complex problems and takes a new perspective on existing solutions; exercises judgment based on the analysis of multiple sources of information

• Impacts a range of customer, operational, project or service activities within own team and other related teams; works within broad guidelines and policies

• Works independently, receives minimal guidance

• Explains difficult or sensitive information; works to build consensus

Transition of Care Planning

• Reviews and assesses selected cases within one business day of admission and as appropriate throughout the patient's stay to assess and execute transition of care planning requirements that ensure timely and appropriate discharges.

• Participates/coordinates in Care Progression Rounds and patient care conferences.

• Utilizes [CM Program/Tool] according to department standards to make Discharge Planning arrangements and document interventions.

• Identifies actual and potential delay in service or treatment and works with the appropriate individuals, including but not limited to, the patient, patient family, caregivers, Social Work and Denials Management to ensure timely action/resolution.

• Works with multidisciplinary staff to ensure patient/family has received appropriate information and education prior to transition to the next level of care.

• Identify and solve problems related to discharge needs, implement a plan of care and coordinate a safe and timely discharge.

• Identify and arrange for provision of skilled home care (nursing, PT/OT, Dietitian, SW, etc.) medical equipment and supplies needed for home care services.

• Coordinate the preparation; delivery and scheduling of infusions, enterals and treatments with patient's hospital care providers and patient's discharge time.

• Collaborate with home care providers for benefits and coverage of home care services.

• Advocate, mediate and negotiate to formulate a cohesive plan for maintaining or enhancing patient's health status and moving the patient safely to the home or next level of care.

• Provide ongoing consultation and training to medical staff and other health care professionals on discharge and home care issues; participate in process improvement activities; identify barriers in service delivery systems and develop a process for improvement.

Utilization Review

• Reviews assigned patient population to ensure that admissions, continued stays and ancillary services are medically necessary, cost-effective and provided in the appropriate setting.

• Using the [CM Program/Tool] work list, determines daily work assignment and performs concurrent chart review.

• Evaluates initial level of care and patient type for all patients to ensure appropriate use of facility resources.

• Interacts with Resident and Attending Physicians as needed to ascertain certain clinical findings to meet the appropriate episode day criteria, length of stay and patient care guidelines and assures appropriate documentation. Escalates to Review Physicians and Physician leaders to support appropriate length of stay (LOS) and patient transitions.

• Discusses admission criteria and expected date of discharge with care team

Quality/Compliance

• Concurrently reviews patient medical records for admission appropriateness, protocol compliance/appropriate variance related to JCAHO/CMS core measures.

• Ensures and facilitates compliance with protocols and the documentation requirements, which may include face to face communications, phone communications and discussion with physicians and clinical staff.

Professional Development

• Stay abreast of payer admission criteria and expected length of stay. Attends appropriate clinical and professional organizations, workshops and meetings.

• Stays abreast of community resources available to facilitate safe patient transitions of care.

• Remains current on clinical advancements related to primary patient population.

• Pro actively seeks to understand areas/roles outside of immediate area/role within department

Other

• Demonstrate customer focused interpersonal skills, utilizing problem solving process and critical thinking.

• Communicate and resolve conflict with physicians, health care team members, community agencies, clients and families with diverse opinions, values and religious/cultural ideas.

• Performs other duties as assigned, including for example, participation in planning sessions for departmental activities.

• Collaborates with health care team on the plan of care, referrals and ongoing needs of the patient. Facilitates communication and coordination of this plan of care with the residents/attending physicians and the health care team. Communication is concurrent and proactive. Goal is to increase quality, efficiency and patient satisfaction while managing LOS and cost for targeted population.

• Works to improve quality through reduction in treatment delay, use of clinical pathways and monitoring of quality indicators. Facilitates timely tests/procedures; obtains lab results; as needed, discusses the implications for discharge with nursing staff and residents. Evaluates with the team, the patient's response to pharmacological and therapeutic treatment regimens. Collaborates in the preparation of discharge forms/paperwork and prescriptions that often delay the discharge.

• Collaborates with the health care team to identify resources available for the patient/family; provides, either directly or through referral. Coordinates the provision of education for patient and family regarding the plan of care and health care needs. Assures implementation and monitors pathways and patient care protocols. Keeps patient and family informed as appropriate.

• Helps to develop, revise and evaluate tools needed to facilitate care coordination and patient care standards. Participates in process improvement and evaluation of patient outcomes for specific patient populations. Collects data on clinical resource management, LOS, readmission

• Documents in Midas as assigned.

[Been there,done that, ASN, RN]

That sounds like 2 jobs in one. How many patients will you be assigned, how many case managers will be working with you, and why did the last one leave? How long would your orientation be?

I am asking this because I talk to many hospital case managers. They are complaining because their caseload is unmanageable. Could be worth it to take it, though. As in bedside nursing.. one year of experience is golden.

[SummerGarden, BSN, MSN, RN]

That sounds like 2 jobs in one. How many patients will you be assigned, how many case managers will be working with you, and why did the last one leave? How long would your orientation be?

I am asking this because I talk to many hospital case managers. They are complaining because their caseload is unmanageable. Could be worth it to take it, though. As in bedside nursing.. one year of experience is golden.

LOL! Hospital case management is a 2 jobs-in-one job if it is organized right. Poor hospital case management jobs are 4-in-1. Specifically, Discharge Planner and UR/UM RN is the typical 2-in-1 position. Poorly run departments require CMs to be Discharge Planners, UR/UM RNs, Clerical Staff, and a Social Workers all-in-one with a ridiculous case load (I've been there and done that myself)!

[Julius Seizure]

They offered me the job this morning!

Yes you are right its probably a very busy job. It is for the PICU and there is currently 1 other PICU case manager - PICU is 44 beds. She said that the last CM left because she was diagnosed with cancer and retired early (was a few years away from retirement anyway). I got the feeling that they may actually have had three and that she might be wanting to hire a third again - she also mentioned another CM had resigned to be a stay at home mom to new twins. They also have several social workers.

I asked about orientation, and it sounds like it is gonna be on the faster side - about 8 weeks side by side with another CM, then I'll start to get pushed out of the nest a bit, but with a resource person to call if I need help with something. Luckily, I am at least familiar with the hospital, since I worked there for a few years. It will be a steep learning curve, but I can do it.

I've been unemployed for a long time and am running out of money, so I am really motivated to accept this job even if its gonna be hard and 2-4 jobs in one. I feel ready for a new challenge, too. And yes, like you said - if I do this for a year and get certified, I know more doors will open to me. (I've gotten lots of rejection emails from the insurance company CM jobs...)

Working a M-F business hours job is gonna be a HUGE change...I'm excited but a little nervous :) Thank you both for the advice on what to ask and consider during the interview process!

[Been there,done that, ASN, RN]

Congrats! 8 weeks IS a little on the short side, but it sounds like a decent orientation. Focus on learning CM principles. I wish I had spent time after each orientation day.. to wrap my head around the daily learning goal.

Best wishes, let us know how it's going.

[SummerGarden, BSN, MSN, RN]

OP: Yeah! Congrats! Welcome to the fold and a year long time of learning and growing in this new specialty.

By the way, 8 weeks is an OK amount of orientation... I received 12 weeks. As the other poster points out, a good practice is to set learning goals for yourself daily. Another is to take patients before you end your orientation while taking the opportunity to use your preceptor as an around-the-clock resource. GL!

[Julius Seizure]

OP: Yeah! Congrats! Welcome to the fold and a year long time of learning and growing in this new specialty.

By the way, 8 weeks is an OK amount of orientation... I received 12 weeks. As the other poster points out, a good practice is to set learning goals for yourself daily. Another is to take patients before you end your orientation while taking the opportunity to use your preceptor as an around-the-clock resource. GL!

Thank you for the encouragement and advice. I will keep that idea in mind.

As a question to all -- are there any specific resources or subjects that would be good for me to read up on in the weeks leading up to my start date? I don't start till January.

[SummerGarden, BSN, MSN, RN]

The Commission for Case Management Certification has a list of resources that are case management focused:

Suggested Reference List | Commission for Case Manager Certification (CCMC)

Some resources can be found cheaply through online book seller websites. I would suggest a textbook on case management, but newbies can find them to be confusing and not very helpful in a pinch. There are much better resources then textbooks that explain parts of case management for a lay person to understand such as primary resources like the CMS website or other local and community websites. There are also very helpful resources in the form of the CCM, ACM, and ANCC exam study materials along with "handbooks" that help break specific information down that can be used in a pinch.