kTIE

What I mean is you will have more opportunities in many different areas and more companies ( if you work for an insurance company, I am surprised they are not asking you to have this cert). I average quite a few offers and this is what I mean by lucrative, in that more opportunities. The salary depends on the company and what the range of the salary would be, but I make alot more than hospital nurses. Whether I am doing hospital case management or working for a medical group. If they are paying you as much w/o a CCM cert, I am wondering why.....are the people with the cert there longer and they desperately needed more nurses or are you more qualified than your peers with a cert? Probably the former......they are hiring new nurses with NO experience at the hospital where I work and it takes them 6 months to grasp concepts.....

Okay, typically I start with my census, looking at the dx, patient;s age and insurance company. I need the dx to plan whether it will be complex ( intracerebral bleed ) vs possible routine ( hip replacement or knee replacement). I look at the age because age is a factor in whether I will need to eval for possible dcp to snf ( i.e. hip fx and pt is 89 yrs old, signals SNF or TCU for rehab ) Insurance is important because all of the following have different problems and issues: a) cash account, b) Medicare or c) Medicaid. Cash account need: social work intervention for dc planning and also this will more likely be a difficult case no matter what the other factors involved. Medicare case require a manditory LOS of three days for skilled, so if it is a ...let say knee replacement, I know it will be three days before I can transfer to a snf vs home with DME. Medicaid is difficult due to the re-imbursement to the doc, and SNF's usually do not take a patient for rehab with just this as a payor, so other problems ensue with this type of payor. Usually after evaluating my census, I attend rounds on the floor ( a common occurance as more hospitals are realizing the importance of rounds. Then I interview the patient and ask the nurse and other disciplines about their interventions and information regarding the patient. Then I make my calls to insurance companies and doctors ( for orders, transfer status, notification of delays or other problems ) Then I make transfer arrangements for all pt's going to other facilities. This is a synopsis of my day......not hour to hour. Hope this helps.

As a hospital base case manager, I have had anywhere from 14-28 patients case load.

The Pro's: You have alot of opportunities to work in very different settings, insurance companies, hospitals, medical groups and private. Your hours are mainly 9-5 and if you choose to, you can work weekend. The pay ( in california ) is about 35-40 per hour based on experience. It is " out of the box" thinking because you need to evaluate the patient, living situation, financial situation, social situation and plan accordingly with taking into consideraton the clinical picture. It is an independent position in that you need to critically think and plan for approx 14-28 patients ( the average I have had to case manage in the hospital setting ) alone ( or with assist from a social worker ) on a floor and plan for patients. It is collaborative in that you work closely with all disciplines ( P.T./ S.T. , social work and the bedside nurse ) to provide care. The CONS: You follow the directive of whomever employs you and usually you are maintaining the fiscal side of healthcare. So you are responsible for bed days, and need to be the "bad person" to the physicians and others who see you as a "discharge planner" of sorts and "throwing the patient out" when you are trying to manage the patient with the appropriate resources. There are couple of 12 hour positions but most are 8 hour ...meaning 5 days a week. There is a different stress in your manager or other superior is looking at your " cost vs.benefit". Hope this helps

I am a CCM and it is lucrative if you are working for an insurance company or medical group. It is a certification that requires you having worked in the field and then you take the test. The certification is good for 5 yrs and you need all CCM CEU's (85 total) for to avoid taking the test again. The CCM test covers rehab, psych, about 1/3 workers comp in the total of contents. And some questions about Medicare, MCAL ( or Medicaid ) and PPO/HMO stuff. You will definitely be more marketable after having the cert.

Most hospitals and some insurance companies use Interqual guidelines to admit patients to the hospital. It is expensive to maintain the books but if you as a case manager ever have to answer to a lawyer as to what criteria you discharged a patient ( if you have the pressure like we do to meed Medicare LOS) you can refer to your Interqual book.

You can also sent him to a board and care if he needs "round the clock" monitoring or just someone to be around in case something goes wrong. This is not covered by Medicaid, but it would be a better situation than home with a person who may not be comfortable with the situation. They will allow nursing into the b/c so this is still possible to have the home care nursing and r/t to provide this support. I sent a couple home when I was a case manager in an ICU of a hospital. Just one family member is a little "iffy" as what if she wants to shop for groceries or needs to leave the home. Is she 24 hour going to be at his side. Does the patient feel comfortable with a trach? Or, if he really is not ready a subacute facility that takes Medicaid may be another option, for suctioning and trach care ( both are covered by Medicare but if no real skilled need other than this he can go custodial). I have sent people with new trach's who cannot care for them to this type of facility...only drawback is his age...they usually do not want young patients and if he is immunocompromised, he would probably get an infection, so they would not accept with a neutropenic status. A w/c van is a good alternative for transport, you probably need to set up 24 hours in advance for transport or if you are aware of a gurney transport ambulance co, there are some still out there I think... Anyway, good luck.

acute rehab is considered acute care. It is billed that way and insurances and Medicare both recognize it as acute care. Where do you get that acute rehab is equal to subacute or snf or tcu?????

You need to report this to your social worker on the floor. She will take it out of your hands and if she feels necessary to report this to A.P.S. Your supervisor will not be able to follow this up as well as the social worker or case manager on your floor who can spend the time investigating and they also have to document their findings. Better for you legally.

In the facility close to our hospital, a patient is basically med surg and all the patient's they accept have to be able to tolerage at least 3-4 hours of speech, occupational and physical therapy. They can have medical conditions that require medical care, but the rehab portion is meeting criteria to be in that facility, so it should be considered acute care. More rehab oriented though....not sure if it would be as challenging as a med surg floor in and of itself.

I was just notified by my last employer that a patient and her husband are filing a lawsuit against the hospital. I have never been to one of these. Should I provide my own counsel or let the hospital represent me during the deposition? Any experiences in this?