New to Case Management - Office Based

Renaylor · Mar 4, 2007

I work in a Long Term Care setting in an office with just myself my managed care coordinator and a Director who oversees the whole operation. My coordinator handles Managed Care from the financial end:levels and negotiation. I am the only Managed Care Case Manager for the facility and I am responsible for Clinical Reviews sent to the insurance companies which will determine continuation of coverage by the insurance company,conversing with other case managers for the insurance companies, and teleconference calls for a specific network of patients. I just got into case management due to burnout from 14 yrs in Geriatric acute care. I lucked out and found this job in Nursing Spectrum. Thankfully it is also 10 minutes away from my home and my little girls school, the benefits and pay were comparable.

I am sure you responsibilties may vary, I am sure you will have some type of coordinator overseeing the operation and you will likely be reviewing cases that have been documented and determine if coverage will continue. You will love the autonomy. The stress is minimal(compared to working as a staff nurse in a acute care Geriatric Medical Unit), and I finally feel respected for what I do. I may not be working directly at the bedside but I feel as if I still make a difference in a residents life. You will also find that your diverse experience will really help you with your decision making and documentation(Nurses after all are great critical thinkers!). It may be scary at first but you will adapt..Nurses always do and you will do great. Good Luck!

dria · Mar 22, 2007

i also work in insurance based case management, and so far it is the best job i have ever had...i've definitely found my niche.

some things i've picked up along the way...

it will take about 6 months before you feel like you really know what you are doing.

don't be afraid to ask questions. and ask them again, and again....

listen to what people say, but remember what they don't say is sometimes more important!

learn to say no (nicely) don't let people (colleagues, members, providers...) manipulate you. they will try.

learn to let things go.

every rule has an exception.

sometimes you need to be a pit bull.

sometimes it is better to ask for forgiveness rather than beg pemission.

when all else fails...beat your head against the wall...because it feels good when you stop!!!!!!!!!!!!!!

best wishes to you in your new role, and feel free to send me a message anytime!

Bluehair · Mar 22, 2007

i also work in insurance based case management, and so far it is the best job i have ever had...i've definitely found my niche.
some things i've picked up along the way...
it will take about 6 months before you feel like you really know what you are doing.
don't be afraid to ask questions. and ask them again, and again....
listen to what people say, but remember what they don't say is sometimes more important!
learn to say no (nicely) don't let people (colleagues, members, providers...) manipulate you. they will try.
learn to let things go.
every rule has an exception.
sometimes you need to be a pit bull.
sometimes it is better to ask for forgiveness rather than beg pemission.
when all else fails...beat your head against the wall...because it feels good when you stop!!!!!!!!!!!!!!
best wishes to you in your new role, and feel free to send me a message anytime!

:rotfl:

lol! am looking at getting into case management myself so i had to read this thread. this advice appplies to every job i have ever had. especially the head banging part! i love it!

NICU_3_RN · Mar 22, 2007

Dria - thanks for your reply! The end of week one - and I keep coming back and I haven't cried yet. So far so good! One of the other new girls says, "look at it like this - at the end of the day you haven't given anyone the wrong med and no one died". I've seen a lot of death lately - so that strikes me as very good advice. I'm a little bit overwhelmed seeing all of the systems I'm going to have to use, but at the end of the day, I'll still be making a difference, and not working 12 hours on my feet to do it. I DID keep my NICU job per diem, so that is nice - and I hope that will keep me from missing the hospital at all.

Thanks again!!

From a new Pediatric Case Manager

dria · Mar 24, 2007

thats a very good perspective....the saying around our office is "no one ever died because you referred them to the wrong disease management program!" not sure how that would apply to "little people," but i'm sure you get the gist.

don't worry about the systems, that will come with time. i see that you are young enough to have some baseline computer literacy...think about how a nurse who has only used a computer to pull lab results would feel.

and yes, you do make a difference!!!!!!!!!!!!!

Kath_RN · Apr 14, 2009

Just wondering where you are working. I would like to transition into case management but remain in pediatrics as well! Do you work in a hospital setting?

cindynavarro · Apr 24, 2009

Nice to hear that there's another side of nursing besides cleaning.... I am very, very interested in doing case management/utilization review. i dont know where to start. I am sooo desperate, I've contacted some schools and they are asking tooo much. I am on disability now and cant do bedside anymore due to my injury. I need help before i go nuts!! I want to take classess to get me to case management, pls. give me some info. I was encouraged by everybody's messages and you gave me hope. so pls. let me know. thanks so much.

cindy

bummer · Nov 18, 2009

I am interviewing for a case management position with a long-term care facility. I have only been a RN for 6 months, but I hate working the floor. I don't like all the deaths I have seen. Can anyone give me some pointers as to what questions might be asked during the interview? Any help would be appreciated

Debbie