Copper4

Hi, I am not sure of your background, but have worked in home based roles in a couple of different jobs. I would not recommend doings so without significant "hands on" experience under your belt. Most at homes jobs are relying upon nurses that have a good clinical understanding of patient issues, or symptoms, treatments plans whatever, usually only gained from clinical experiences.

I think I am late here. I worked for a managed care company doing disease management, as with everything there was both good and bad. I have always enjoyed the patient teaching aspect of nursing, so that was a positive, especially if an eager client. Down side is that job performance was completely based on the quantity of calls, and there was an expectation, unfortunately calls out, did not equal calls made, the person has to answer the phone. I worked in heart disease, so many of the calls were made to people who were working, therefore evening calls were necessary. My primary gripe was with the quotas, at that time the goal was 10-15 calls a day.

I am from the Northeast as well, but only work case management per diem. I knew RAC's were coming, but have not heard anything more in terms of the effect on payment. How has it been working at your hospital? Are they recouping money, or requesting additional info ( not even sure that is an option)?? curious how this is working??:)

My understanding is that Observation status is considered to be an outpatient status. It drives me a little nuts when people state that she was "... admitted to observation status", when in reality she has not been admitted at all. The patient did not meet inpatient level of care criteria or she would have been made an inpatient. . Observation is paid under medicare part b, and after deductible it covers at 80%. A medicare supplement would likely pick up the other portion. This often times comes as a surprise to patients especially when they are in a johnny, and in a bed. The hospital i work at has started giving out an observation status letter of explanation, in an effort to avoid lots of complaints when the bills arrive. It also is extremely important for the medicare patient to understand that these days are not considered under the 3 day qualifying stay rule that can enable coverage at an SNF, if appropriate skilled need is evident. At times people are in observation status for many days, we often times have to tell them that even if she was admitted, the days would not be considered qualifying days. It is all about level of care and appropriate use of resources. Hospitals are running scared because of the expected RAC's that medicare is implementing that may require hospitals to pay back funds, if audits determine that the level of care billed was not appropriate. OMG if this happens it could put hospitals out of business!!

I have requested an opportunity to shadow with a potential employer in the past- I feel it gave me a much better understanding of the expectations of the role I was looking to fill-- I would take it as a good sign- be yourself, ask intelligent questions, and decide if this is a job you would like. Good luck!

I really think it depends on what type of case management you will be doing. I have worked in acute care case management as well as an insurance company. i feel by overall knowledge about healthcare and processes has grown over the years, because you really do need to know what you are talking about when dealing with patients/ families/doctors/insurance companies/vendors/agencies etc... however, the term case management is tossed about very freely these days. I do believe in homecare, what we used to call primary care nurses, are sometimes referred to as case managers because they coordinate a variety of services. i would recommend as stated earlier going to the specialty site here, or trying the case management association for more info. I am a certified CM and have been able to work in a variety of settings, but for a long time continued to work per diem as a visiting nurse. I do feel you lose the " hands on" skills and confidence if not using them, so that may be another option. I have never heard of a new nurse being hired as a case manager, because of the need for a well rounded knowledge base. Good Luck!

If they are capable of giving out their own meds, then why do they need rehab-- I am still in the learning phase about the new MDS twists, but complex medical patients are important, and I think ADL needs are going to be weighted at higher rates. i too am not sure who are the best to take these days when there are actually choices ...sometimes there are so many empty beds, anybody looks good.

I am not sure if this would be considered fraud or not. The subacute facility I work for no longer allows patient's to bring any of their own medications. Apparently the lawyers have determined that we cannot do this ( we did in the past). My understanding of the rational is that when a patient is going to an ltc for rehab under medicare payment, the facility is required to provide for their needs,as part of their rug rates. Medications are included. I do not know how other facilities work this out,although I know they do, but we are no longer able to do so.

Is that something that can be detailed in a living will? i know I need to put my desires in writing, my husband will totally not get it. Good luck with this case. We have a resident with very debilitating MS, they were just able to extubate her , again, spouse just cannot let her go... so sad.

I really do not think case management is the place for you, at least not in a hospital or insurance environment-- case managers are totally involved with the health care industry/business, and have to be very aware of what is going on and how to adhere to these guidelines and limitations while still advocating if possible for their clients. Maybe a clinic, or community based case management position, but I would advise you to steer away from the others. Just my two cents... but there are other options out there, good luck!

I agree with a couple of the other posters- and also am sorry for your Dad- I do believe also that your step mother is the legal decision maker if no others have been defined-- i would suggest you speak to the doctor or nurse, and ask them to speak to your step mother about positive feedback, and the assumption a patient can hear all that is spoken whether he can respond or not. Maybe that will get the point across to the family members that are negative, and hopefully encourage them to speak to him in a more positive manner while taking the burden off of you. Good Luck!

With the concern for RAC's, i think the weekend staffing will be increasing. The concern being that medicare can review for appropriate level of care in retrospect and recoup monies if not appropriate. I am only per diem in case management, work about a weekend/month , but they are likely to increase the weekend expectation which is tough if you did not sign up for it..

I was fortunate to work from home- I started with the company, out at the hospital in the mornings, then in a cubbie in the afternoon and hated it-- then, the company decided they would save significant money setting our department up from home-- so I lucked out! I know some other companies including Aetna, and Anthem base their hospital case managers, meaning Utilitation Management RN's, from home after a period of time. UM was difficult from me at first so be aware- you reallly are not expected to be a patient advocate. You are an insurance company advocate--the idea is the save the company money! bottom line! Much more a business model, although even acute care case managers have to review for level of care these days. You must determine if the patients meet acute level of care criteria, if not , they need to be discharged or the hospital may get a denial. in the subacute area the patient gets the denial. i was sometimes very conflicted. I also worked in dissease management briefly-- the job itself was ok, alot of teaching to members over the phone. the problem is you are judged on how many people you call. If the program you work for has a lot of working age folks, you may have to work off hours to reach people. In terms of finding the jobs, Try career builders, or other search engines. I also have recruiters calling me fairly often-- good luck!

You didn't mention what type of case management you will be doing? I was home based for 6yrs working for an insurance company- I would go to the hospitals in the morning to review for utilization purposes, but then from home to contact Md's and smaller outlier hospitals--my advice to you is to get to know you peers. Get their home numbers and reach out during the day, be it to just say hello, or to discuss difficult cases--I loved working from home, and it worked for me and my family at that point in my life- but sometimes it can get lonely and you can feel a bit isolated, so if you can make contacts, and friends with your coworkers it can help when you have some down time and are wondering what is going on out in the world! Good Luck in you new position.

No matter what your role, if you are thoughtful and smart, and always do what is best for the patient, you will do fine..(.if that means asserting yourself with a doctor or family member so be it-you are doing your job):)