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Discussion

Need Help

Just started a Case Management job in January. I have 4 years experience as a Med/Surg - ER nurse. I recently graduated from an RN-BSN program.

I have never been in Case Management before, I work for a small hospital, I have been there since before becoming a nurse. I have found it really hard to find my may with very little training. All I have is a book of Physician Developed Criteria that is pretty old and sometimes hard to decipher.

This position is really new for the hospital also, many of the duties are new. We have a 25 bed critical access facility that also includes SNF capabilities for therapies.

I sure could use some advice and suggestions to work my way through this if anyone has thoughts!

Thanks a bunch!

Featured Replies

First of all... what does your boss say your role is, how is your role defined, job description or delineation. Are they having you doing the UR, insurance reviews initials or concurrents or both? Are you responsible for developing a dc plan of care, and seeing that thru to the end?? Do you see all pts or only a select population?? I recommend you have a copy of Milliman or McKesson Level of Care Criteria, whichever your hospital uses (they should provide u a copy, my boss does); you will be helped by having that if you need to do concurrent reviews with payors. There are some good texts available -> for self education and reading I recommend Cohen or Mullahy; but you can go Google or Half.com and try a search. You an PM me if you need other info or I didn't answer your questions.

CaseManager1947,

I don't know what I have done to my account, but I can't post or send PM's, this is JinJerEvansRN! I had to create another profile to be able to post to you! I would appreciate any help that I could get. Please email me at [email protected].

So sorry for the inconvenience!!

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