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I an an Interqual Certified Instructor, you would need to ask your management team if you are able to call Change Health Care( formerly McKesson) in reference to your question or if there is a chain of command to follow before actually making the call to them directly. It is my understanding that facilities have a fee for calls that are made to Change Health Care. Make sure to read the little information notes , they are very helpful . Read the front page ( on the computer) for the subset you pick. There is no bending of the clinical information. You either have the information or you do not. You can not read into the clinical information provided.

First I thought of, What level of care are they in Med surge or ICU, are they getting IV antibiotics, if not , I think they should be to address the the crackles usually indicative of pneumonia. What does the chest x ray show, was infectious diseases consulted, sputum culture or nasal pharnyx washing sent? I am sure that with a sat of 80 the patient is getting oxygen, but with someone who has chronic lung disease, as you would with the extensive smoking and bronchitis history, they may routinely pulsox 85-89% and not be in acute respiratory distress. Those folks live with these low pulsoxes everyday, its just that no one is actually checking their pulsox every day when they are home. Were blood cultures done? Where is this patients CO2 by abg or even blood metabolic panel? 15,000WBC's are elevated but many, many people do not develop fevers until thier WBCs are over 20 or higher.They may take herbal supplements to boost their immunity, be well hydrated,and not yet exhibiting a fever. The other concern is are there actually no breath sounds on the one side possible requiring the need for a chest tube? This is probably not exactly what you were looking for but absolutely pertinent questions given the case study details described.

I cracked up at the adlockwood post, how true is that - in hospital you do it all, utilization review and discharge planning , insurance medication authorization, for insurance company, you take calls all day from the hospital folks doing case mangement setting up home care auths and doing your assisgned hospital caseloads, which change daily as patients come and go out of the hospital- then you need to do daily reports and update census info

I would expect around $55,000-60,000 no weekends or holidays, generous vacations and eventual ability to work at home

Question 1) ROle, I am a discharge planner, case manager and utizilation review coordinator at a large hospital My role is to coordinate or buzz word, Transition to the next level of care for patients going home- do they require home care, have durable medical equiptment needs like a commode or a walker or oxygen, I am responsible to set those services up after I assess the need, speak with the medical team and ask social work to intervene if appropriate. I am responsible for giving the patient resources that may asassist them at home, like aging services, supPort groups, - communication between the medical team, the family and the next level of care providers is vital 2)Since in my role I have responsibilty in utilization review - older clinically experienced nurses do well here, varied backgrounds in many different specialties for the discharge planner, case manger role, my background in high tech trach and vent home care was very beneficial, another requirement, you can not be shy, you will call a lot of companies and only half know what you are talking about and then need to ask a ton of questions so you kinda get it by the end of your conversations- I had no competencies, and just learned on the job, however you must have a good set of community resources to fall back on 3) While the patient is inpatient the role is to communicate barriers to discharge to the family, patient, medical team ie: patient is 80 and lives alone and does not have available family to assist with IV antibiotic infusions, this would be a problem, so when MD says they are ready for discharge tomorrow.... Not so fast I tell them, we have kinks that need to be worked out first as they transition to another level of care home - by setting up home care the hope is to decrease readmission rates by empowering patients to take control of their health with the assistance of the home care team or referring anf identifying the patient to case mangement ( private insurers Aetna,managed medicaids)through the UR process when you call - if a patient lacks the resources at home to care for themselves, be it lack of money for getting scripts filled or no heat- if you can assist with these resources prior to discharge or give the patient the tools to follow up when home- improved outcomes 4) IN the discharge planning mode not really, I do no direct patient care, but with the utilization review piece, where you call all the insurance companies and let them know why the patient is in the hospital and what you are doing every day and how they are progressing towards discharge, we use a set of giudelines that determines the severity of the illness and the intensity of services rendered to see if they could be more cost effectively served at a different level of care ie: acute rehab or skilled nursing facility

It depends where you live. Apartments in the city Philadelphia can be 900-1000 a month. Parking is also another concern.At the VA in Philadelphia, you are a short drive , less than 20 minutes from New Jersey and can find single family homes for 900-1000 a month. The acuity at the VA is not too bad, they ship all thier serious cases to the Hospital of the University of Pennsylvania, that is only around the corner, once they are stablized, they go back to the VA ICU. THe Philadelphia area has so much to do. If you do live in Center City, get yourself a good bike and a lock. Traffic is a mess all around the VA every single day at rush hour. Best of luck to you

YOu must be disciplined. All the programs vary as to the requirements, many 2-3 posts a week, daily logins and a paper at the end. It is definitely manageable to do online classes. I had not been in school for 18 yrs and found it very beneficial to take a program that offered a mixed program. I went RN to BSN and took 11 undergraduate online classes. This was great because most of my nursings were face to face and I could get the clarification of the project guidelines. In online programs, you get what you put into them. You can get by or work really hard and and learn a lot. I found, in nursing there were no tests to study for, but I will give you a prime example of why a face to face class is a benefit. Health assessment, I never had an assessment class in nursing school. This class taught me to palpate the thyroid, and practice assessment skills that are not necessary in everyday practice. I also found the the mix of the 2 to be great. I took informatics and computers , pharmacology, english, world nursing, nursing theory, to name a few on line and took, nursing courses in person. I did this through Rowan's progran with UMDNJ and it was great. My suggestion, would be to see if any programs have the ability to do both. Best of both worlds.

I would suggest BSN first. I understand the lure of making money sooner, but if you have a BSN, you have more career options. The magnet facilities and the hospitals that are trying to get magnet status, only hire BSN's for inpatient care. I worked with a diploma of nursing as an RN for 18 yrs before I went back and got my BSN. I wish I did it the first time around. Pay is just about the same, just more career options. I wish someone would have told me the need for the BSN 20 yrs ago.

I have used interqual over 2 years, it is not possible to meet interqual unless they are having significant pain and on a narcotic, morphine/dilauded drip, or if they require >40% oxygen. Comfort care for comfort. They won't meet, but if they are medicare, as long as they met during their hospitalization, they shoul be covered. Never fudge on interqual just to make someone meet. If they don't meet, they don't meet.

I work for a large metropoliton hospital. The best way to anticipate needs, is to talk to the patient and the family, caregiver and ask, a hone call is very apropriate for a demented family member . What do you already have, give suggestions based on PT and OT assesssment and then ask if they have any equiptment, where is it from. Private insurers can tell you where they have made claims, not so with medicare for DME. For home care in medicare, it comes up as to which company is on board. I usually do not know of needs until the day of discharge. I always try to arrange delivery the day before or the day of, but many times it is not delivered until the next day, the only exception is home O2. It must first be delivered to the hospital, patient instructed on the use of it and then they call the DME company and let them know they are physically home. Always give the patient the # of the DME company, with what is to be delivered. Also, make sure when you get medicare patients, that you ask the DME company how much the patients financial responsibility is.Inform the patient. ie: ordered a commode for a patient, the 3 in 1 commode is 100 dollars, the patient is responsible for 20$., This avoids surprises for the patient and the family when billed from the DME.

I also sent you something to your mailbox.

I have worked for Bayada nurses for almost 16 years, I found thier test to be just as a previous writer said, what would you do in a certain situation. I have had to take that test multiple times throughout my employment as I worked for various offices, each time, the nurse that reviewed the test, was happy to review the results and they were up for discusion if they were wrong according to their answer key. The medication test is simple. Read the directions reread the question and cross multiply. I found Bayada to be very supportive when I had clinical questions when out in the field. One piece of advice, if you have a question about care issues call your nursing supervisor, anytime, day or night, your excellent, caring, reliable and skilled care depend on good judgement every time.

Well, I think home health or hospice visits have more freedom, than a hospital based job and are a little flexible wheather you work part or full time. There is nothing easy about any part of nursing, either LPN or RN. If you reallly want to be a nurse, then go to school as an RN program and not an LPN, there are not many jobs for LPN's that do not require you to bathe, wipe butts at least for some time after you graduate.Do RN's do that?, most yes, some have been nurses for 20 years and don't have to now , but did for many years. Have you ever considered Physical therapy or occupational therapy, nursing with little babies? You can not get into case management right out of school, you need experience. There are many jobs in my area, but they want experienced RN's.

Pediatric cardiology seems too specific for home CM. You could possibly get a CM position that works from home eventually in pediatrics though. To become CM certified you need to work 1 year under a certified case manager or 2 yrs doing it not under a certifie case manager, then you sit or an exam. Type in on allnurses.com case managemnt certification, there are specific guidelines on the website. This website is invaluable, scroll through some of the different posts, others have asked the same questions. Good luck.

Why doesn't medicare pay for IV antibiotics? I hate the idea of sending someone with medicare as only insurance to a skilled nursing facilty (SNF) for the duration of the IV antibiotics. Doesn't Medicare see that this is a huge waste of resources by sending someone to a SNF if they don't have physical therapy needs, just a PICC or a midline and the need for IV antibiotics? This is a lose-lose situation, patient has to wait for bed availability and then risks getting an infection while at the snf. It can't be about money or they would open their eyes and see how wasteful it is. Does anyone know of a way to get medicare to cover it if there is no other secondary insurance? Does AARP coverage cover IV antibiotics if it is a secondary. Also if someone is a VA player ,and greater than 65 is it possible the VA would cover home IV antibiotics. Are there any free standing IV rooms, as part of a hospital, that are willing to put an IV in a confused patient daily for a week or two while the IV runs in as long as there is a caregiver at their side? I would appreciate any names of IV centers in the states of New Jersey, Pennsylvania or Delaware.

Not inpatient!Totally overstressed always more work pile on.

I went to Frankford, many years ago (20 to be exact) Best of luck to you.!!!!!! Back then, you did not need to take a test.

As a case manager, I look for facilities to place patient's in that have frequent successful outcomes. If you explain this to your administrationis they have to see that this is what builds rereferrals. You are trying to sell substandard facilites even though you may have a rockin' staff. I give you a piece of advice. A few years ago, I worked at a summer camp., I loved the principals of it and the staff was always excellent, under an excellent director, but when parents came for open house, they were disappointed in the physical surroundings and lack of upgrades. They rather chose more expensive camps that had better physical surroundings -the lack of upgrades is really a true reflection of the financial well being of the organization. Afte iworked there for 8 years, the place just closed down and they were not able to sell it, it has beeen vacant for at least a year, due to extensive work that needed to be done, no investors wanted to rehab it.

In my large city, these pts get evaluated by the Corporation for Aging, medicaid applications are started and we wait until the actual application goes through. Many times , I have seen social workers send out over 50 referrals for facilities as far as 50 miles away, just to get them to see if they will ac cept the pt. That's a lot of faxes to send. We have had patients sit 6-7 monthes awaiting payor source and an accepting facility. Try doing this with an illegal, very ill immigrant. emergency medicaide due to hardship is possible but only good for 1 year.

Cardio Trans, I had to laugh, how many times has that happened? They think that when we say day 56 we really mean day 89, they do not understand we don't make the rules, we just have to abide by them.. LOL

I work in a 700+ bed urban hospital, case management is the discharge planner and the utilization review department. Utilization review calls all the insureers and lets them know why the pt is admitted to the hospital, what the hospital is doing and what the discharge plan is.These have to be done every 2-3 days and every time the pt goes from one unit to another. I help people who need something at discharge ie.. if you come in with pneumonia, when you leave if you need a nebulizer machine, oxygen at home and intravenous antibiotics, I arrange all that. Since everyone has different kinds of insurance, not everything is always covered, so leg work is required to find out if the thing is covered. Some people need a medicne but have no perscription coverage, I facilitate the referral to the companies that manufacture certain drugs to be goiven ti the patient for free, example lovenox, linezolid, tarceva. Liabilities include - patients come from less than ideal environments and you are sending them back to a potentially unsafe situation. ie If a patient comes in dirty and disheveled and has a high glucose, they are eldery, have no family support and live alone and are oriented and can make their own decisions they decide to go home and make bad choices (doing drugs and alcohol)and you know they will not be compliant with the treatment plan or they will not show up to follow up appointments, you have to be right on time with documentation that you instructed, gave information on how to follow up or offered home nursing services that they refused because they don't want anyone to see the conditions they live in. Ethical dillemmas abound when a patient is not competent to make decisions for themselves, although they may be oriented, they do not have "decision making capacity", have no family... When a pt thinks they can care for themselves but they are too unsteady or medically unable, do you send them off to a nursing home or back to their home where they can not take care of provideing themselves with food, or paying the bills. When to call protective services when you find out about elder abuse happening to get the elderly persons check.. how about when the family refuses to let the loved one go in a nursing home, but they know full well they niether have the desire to care for or will not be available, because they work to care for a family member that requires way more care than they can provide. Ethical dilemmas because insurance does not cover home nursing care for more than just a few visits and most people can not afford private duty nurse care. It is an ethical dillema when insurance won't cover all the things a patient needs at dicharge, otr they have no insurance and can't get things like home oxygen or drug and alcohol rehab. How about the homeless, is it ever fair to turn them back on the street when it is 10 degrees out?

I work on a 40 bed medical unit- I am responsible for 20 in pt all discharge planning, except those that are going to another level of care, our social workers handle that. I work in an urban medical center and have all the no insurance issues. It took me about 8 mos as a newbie to get used to all the functions of my role. The unified role keeps you in the loop, but wait till you see how busy you are, I end up working 10-12 hrs a day. I know there is no one else who can do my job or follow up tommorrow.

I always have 20 patients for all utilization and discharge planning needs that go home. If someone goes to any type of alternative care setting, they are managed by the social worker. My job would be more manageable if there were 1 more social workers for the unit. We have rounds for an hour a day, 5 staff meetings a month and I turnover 8-10 onto a discharge list every day from a med surge unit. Do any of the utilization nurses out there use canopy to document?

From what I know, you have to be employed in a hospital first in another capacity before they will pay for your schooling to be a nurse. Transport, billing, and CNA or receptionist, I had to work 6 monthes first full time, part times get tuition for school prorated. From what I know, you do not tell the employer straight off the bat, you wait until you get your feet wet first, because you will have to signa a contract to work for them for a certain period of time, I know 6 months per semester after you're done is normal, so if school takes 8 semesters than you would be locked in for employment for 4 yrs. Sounds good, but if you leave before then, you owe all the money back to the employer by your last day, in the past, they withheld my pay when I left and then sick collections on you for breaching the contract.

I'Ve been a discharge planner for a year, but I also share the DCP responsibility with the utilization review responsibilities also. Do you want to be challenged every day? At 45 yrs old, I would like to settle in and just do the job without extra aggravation. Can we trade jobs? LOL