Newbie Questions about case management

renerian, BSN, RN · Dec 31, 2002

Do you mean managed care case manager or home health case manager? Wondered so I can give you the information your looking for.

renerian

502Nurse · Dec 31, 2002

Told you I was a newbie...I'm not even sure of all the areas you can work in case mgmt! At this point I think I'd be interested in learning which one would be more likely to hire someone newer to the field ie. without having had years of med/surge exp.

:)

renerian, BSN, RN · Dec 31, 2002

Lets see you could do home health case management which includes some hands on care and care coordination. Usually do not need to be certified for that care. Need some general acute care experience to expand on your skills unless you get into a good preceptor program. For case management in the insurance or managed care entity certification is good and usually required. No patient care but care coordination and lots of phone time. Which one sounds more interesting?

renerian

502Nurse · Dec 31, 2002

Renerian: you are a wealth of information! How much general acute care exp is needed for a good skills base in case mgmt? Do many places offer preceptorship programs? That sounds interesting to me. Did you get your certification? What is involved in that - is it independent study, an online program or experience in the field?

LasVegasRN · Dec 31, 2002

Here is a thread that addresses most of your questions:

https://allnurses.com/forums/showthread.php?s=&threadid=23356

renerian, BSN, RN · Dec 31, 2002

I did not take the certification as I worked in home health 11 years. Some home health companies have preceptor programs which range from 6 months to one year for home health. I did HEDIS data collection by contract for three years for insurance companies/credentialing firms and I did not need to be certified for that.

renerian

LasVegasRN · Dec 31, 2002

Should also add you cannot get certified as a case manager or sit for the exam unless you have functioned or work in an environment where case management is performed. You'll want to check the website for case management certification. Most employers will hire you with the understanding that you will sit for the exam after a year. Some will even pay for your certification.

ceecel.dee, MSN, RN · Jan 21, 2003

How close is Discharge Planner to this?

ryaninmtv, ADN, ASN, BSN, MSN, LPN, RN · Jan 21, 2003

Discharge planner, in my experience, is close but not quite in the ball park as far as CCM exam qualification is concerned. There are a number of functions discharge planners do that are similar with case management. Outplacement (rehab, subacute, long-term care, etc.) are areas that overlap. On some levels, there may be coordination of care such as follow-up with specialists and the like. Vegas has proven to be the CM guru. I will defer to her at this point.

LasVegasRN · Jan 23, 2003

Last I heard, discharge planners in the acute care settings were not able to sit for the CCM exam. This was mostly because in most facilities the discharge planner does not follow the patient during the entire care continuum. For example, at my facility, I do the care management for the patients in surgical ICU. My primary focus is on appropriateness of an intensive care stay, trying to get patient's trach'd who have been on a vent for a long period of time, transferring to LTAC's whenever possible, and doing as many interviews with the family before the patient leaves the unit. There are many other facets to my job I have to perform (i.e. calling in reviews to insurance companies) but those are the most important. Once the patient leaves the unit, another nurse picks up the care planning from there.

On the regular floors, those nurses would have more experience in working with placement to nursing homes, skilled nursing facilities, transferring to other facilities, etc., where I would not as the patient's in the unit are too critical.

The Commission for Case Management feels that unless you are following that patient from admission through discharge, you are not performing all the functions of case management. I partially disagree with this thinking, but I think the commission is reconsidering their stance on this issue.

The most areas where people have an easier time in getting the experience and exposure they need in order to sit for the exam is in workers compensation, disability management, and disease management.

Does that answer your question or give you an idea?

(Thanks for the compliment, ryaninmtv :) )