New to Case Management-Any Advice?

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Hi All,

I was recently hired as an in-patient case manager at a large, local hospital. I am brand new to case management and have been a nurse for about five years, mostly on med/surg and telemetry. Anyway, I will be starting my new position in a couple weeks and will have a 6-8 week orientation. Does anyone have any advice as to how to be successful in this new role? Anything I can do, read, or study, before I begin that will help? I am nervous, since it is so different from bedside nursing, but excited about a new chapter!

Thanks!!!

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Hi I just started in case ngt as well and im in my 6th week orientation already. Before I started i bought a book on case management and read alot. Milleman care guidelines and Interqual are new to me too. When I'm off I read MCG and write down things i have to know that helps me recommend a patient to be inpatient or observation. I work in the ED by the way. My experience is telemetry and med surg for 16 years and 5 years in long term care

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Thanks for the response! How are you liking case management so far? What book did you buy to read beforehand?

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It's different and I have more responsibilities as a nurse. It's critical that you need to know what signs and symptoms, diagnosis that the payers and the CMS will accept based od their status (observation or inpatient) in order to get reimbursed.

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Specializes in GENERAL.

OP:

Always follow-up with your faxes and orders that you send to the home healthcare company.

Find out:

Did they receive them? (get names)

Are the orders complete?*

Is the case assigned to someone?

For instance:

*ABX : What kind? What's the dosage? How often?

*O2: How much?

Remember just because you got a faxed confirmation doesn't mean all the orders went through.

Don't make assumptions. Trust but verify.

This way you can truly be not a starry eyed optimist that gets thrown under bus but one in the driver's seat.

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I would highlight BUYER's comment of "[Don't make assumptions. Trust but verify. " this is critical if you are driving the discharge plan. You also need to be careful of the politics of the job; there can be some real land mines out there. Talk to your senior coworkers for tips on avoiding them.

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Specializes in Utilization Review, Critical Care, OR, SNF.

The insurance company, contrary to belief, is not your enemy. Find out who the health plan case managers are for your facility/unit/what-have-you and say Hi. I have relationships with acute hospital CMs/discharge planners all over the country, and they are always amazed.....YOU are here to HELP me??? Yep. We want to move the discharge plan along too, and any help I can give, within my scope, I'm there. I arrange transportation, call the medical director, get the approval, organize the doc to doc, etc. and get back to you. Let them help you, and don't come at them with the "insurance company is the devil" attitude, and you'll be amazed at the result.

Good luck in your new role--I love case management, and hope you will too!

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Specializes in Government.

I've been an RN case manager for 20 years. It is critical to be disciplined and organized in your thinking and your desk. Its super easy to get behind and a pain to catch up. I have a CRRN so I don't have any advise about the CCM test. If you are working with non-medical people, remember how many teaching moments there are in a day.

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