New Nurse Case Manager

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Specializes in wound care, home health.

Hello

I just landed a position as a nurse case manager with an insurance company, remotely.

Any advice in how to prepare for this position? This is a whole new world to me. I have been a nurse for 7 years, but no bedside experience. Is there anything that I should read up on? I am so excited and nervous about this new chapter in my career. 

 

Thanks!!

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It really depends on what population you will be working with. Insurance CM can be any number of different things e.g.  Disease mgmt, inpatient your/DC planning, or LTC (MLTSS medicaid).  

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Specializes in Cardiac, NICU, CM, LNC, Forensic, LCP.

Congratulations on your new nurse case manager position! Here are some resources that should help:

https://casemanagementinstitute.com/

https://cmsa.org/

https://ccmcertification.org/

 

 

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Good luck with your new position. I am retiring from a federal nurse job next year and would like to work remotely as a case manager and don’t have experience but worked in a clinic several years. Can you share what company you’ll be working for and can you live anywhere?

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Specializes in wound care, home health.
5 hours ago, lMCRN said:

Good luck with your new position. I am retiring from a federal nurse job next year and would like to work remotely as a case manager and don’t have experience but worked in a clinic several years. Can you share what company you’ll be working for and can you live anywhere?

Thank you. I searched remote RN jobs on indeed. I was told that if the job location indicates United States, then you can live anywhere in the U.S. I also searched remoted jobs within my state. Some companies that I applied for case manager were CVS, Unitedhealth group, Aetna and anthem.

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On 4/30/2021 at 10:21 AM, syronrs14 said:

Hello

I just landed a position as a nurse case manager with an insurance company, remotely.

Any advice in how to prepare for this position? This is a whole new world to me. I have been a nurse for 7 years, but no bedside experience. Is there anything that I should read up on? I am so excited and nervous about this new chapter in my career. 

 

Thanks!!

Hi, can I ask what nursing background you had that wasn’t bedside? I want to break into a remote case management role as well but so far I’ve only seen the requirements including experience in the acute care setting. 

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Specializes in wound care, home health.

Hello.

Outside of bedside I have experience in home health. I only worked bedside a few months. Most of my experience is as a wound care nurse.

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I don't mean to hi-jack this thread, but it's old, and I can't Ctrl-f "new", "topic" "post" or find any button for new post.

I just had a worker's comp phone interview. We talked for 70 min, they wanted to schedule a zoom call, and my recuiter said they called & asked for my address to mail me something, so I am hopeful. I had a similar interview last year and went down a YouTube rabbit hole, asked tons of technical questions (to show my interest and awareness of need to learn) and they said I was nice, but too many questions.

I just took a general CM "course" (video w/ test) and I have very applicable exp with 10 years in home health. I am curious about the documentation, and texted the interviewer "thank you, etc... could you email me some of your documents so I can get an idea what to expect" I am trying really hard not to ask questions but...

Anyway, what I'm really concerned about is local resources available for clients. In home health I had a a fairly finite list of things I could provide and that generally meant telling my team or pt's PCP to order something. I suspect I will be needing a wider range of services in WC, and I will be more directly involved in acquiring them. Is this correct? are there any experienced silicon valley nurses w/ specific resources, or anyone with general advice on what is available and how to find it?

After my interview I am less worried about knowing specific diagnoses, their typical POC, timelines etc. The interviewer said they subscribe to a EBG site that provides care algorithms by ICD-10 code. But I do not feel prepared to look over an MD's shoulder in an office visit and remind him to order an MRI. I have never been bed side either. any advice short of auditing 3 years worth of patho classes in the next week?

Am I missing some knowledge deficit I SHOULD be worrying about, coming from home health?

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