need crash course in CM101!

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Ok, guys and gals! I just recently landed a job with a large health provider company as a CHF case manager. I don't have the slightest idea of how insurance companies work, how they function, and how their different programs(hmo vs ppo vs pos vs i'm sure there's lots of stuff like medicare and medical and other stuff) work:uhoh3: ! Can anyone give me a crash course in insurance lingo and what the basics are for each type of insurance coverage. How do these companies work and what do they look for from case managers. What does the term medically indigent mean? Please help!!!!:)

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Specializes in Nephrology, Cardiology, ER, ICU.

I'm an ER CM but hopefully I can point you in the right direction: I belong to the American Case Managers Association - they have a website and you can give them a call too to get more literature. At one point, I belonged to a case managers bulletin board but am unsure if it still exists - you might try googling that too. Medically indigent in the world of ER nursing means the pt doesn't have insurance at all - even Medicaid. Very difficult to find resources for these pts. Also, if you work with an advanced practice nurse in the CHF clinic - you might pick their brain too. Good luck - if I come across anything - I'll let you know.

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Dear TraumaRUs:

Thank you for answering me. That is great information. I will look up the resources you suggested. It sounds like you are very well versed and experienced. Just the kind of person I needed help from!:p

Let me ask another question, if I may, medical/medicare guidelines, how did you learn those? Is it possible to ever know them all? Is it just by hands on work that you get familiar with them? Also, I 'd like you advice on something, so I think I'll PM you! Thanks again!

I'm an ER CM but hopefully I can point you in the right direction: I belong to the American Case Managers Association - they have a website and you can give them a call too to get more literature. At one point, I belonged to a case managers bulletin board but am unsure if it still exists - you might try googling that too. Medically indigent in the world of ER nursing means the pt doesn't have insurance at all - even Medicaid. Very difficult to find resources for these pts. Also, if you work with an advanced practice nurse in the CHF clinic - you might pick their brain too. Good luck - if I come across anything - I'll let you know.
Up Vote Up Vote ×

Dear TraumaRUs:

Thank you for answering me. That is great information. I will look up the resources you suggested. It sounds like you are very well versed and experienced. Just the kind of person I needed help from!:p

Let me ask another question, if I may, medical/medicare guidelines, how did you learn those? Is it possible to ever know them all? Is it just by hands on work that you get familiar with them? Also, I 'd like you advice on something, so I think I'll PM you! Thanks again!

I'm an ER CM but hopefully I can point you in the right direction: I belong to the American Case Managers Association - they have a website and you can give them a call too to get more literature. At one point, I belonged to a case managers bulletin board but am unsure if it still exists - you might try googling that too. Medically indigent in the world of ER nursing means the pt doesn't have insurance at all - even Medicaid. Very difficult to find resources for these pts. Also, if you work with an advanced practice nurse in the CHF clinic - you might pick their brain too. Good luck - if I come across anything - I'll let you know.
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Specializes in NICU, Educ, IC, CM, EOC.

There is a good bboard at rncasemanager.com

The site makes several references to CM reference texts that are available. I learned on the job. The medicare web site is good for getting up to date information; the regs change frequently so the site is great for keeping on top of things. Sorry, don't have that web site available, just google medicare and look for a ".gov" site.

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Thanks for your comments and suggestions!!!!!!!:)

There is a good bboard at rncasemanager.com

The site makes several references to CM reference texts that are available. I learned on the job. The medicare web site is good for getting up to date information; the regs change frequently so the site is great for keeping on top of things. Sorry, don't have that web site available, just google medicare and look for a ".gov" site.

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Specializes in OB, M/S, HH, Medical Imaging RN.
Thanks for your comments and suggestions!!!!!!!:)
CONGRATULATIONS on your new job. I recently got hired to cross train in the ER in case management. My goal is to do case management on the floor but am willing to do anything to get my foot in the door. I've heard that 28 years clinical experience is a big plus. I will soon be 50 y/o and feeling the need to slow the pace down a bit. ER case management is still 12 hour shifts / 7 days a week. Case Management on the floor is Mon-Fri 8:30 - 4:30 Woo Hoo !

(Formerly RN1976Nurse)

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CONGRATULATIONS!!!!!!!!

28 YEARS OF EXPERIENCE...Wow.....you'll be a natural, it will be so easy for you to transition 'cause of your background. Let me know how it goes, k?

CONGRATULATIONS on your new job. I recently got hired to cross train in the ER in case management. My goal is to do case management on the floor but am willing to do anything to get my foot in the door. I've heard that 28 years clinical experience is a big plus. I will soon be 50 y/o and feeling the need to slow the pace down a bit. ER case management is still 12 hour shifts / 7 days a week. Case Management on the floor is Mon-Fri 8:30 - 4:30 Woo Hoo !

(Formerly RN1976Nurse)

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