EllbellRN

I would still continue to apply for any job you are interested in, even if you don't have all the requirements. A strong healthcare background is very appealing to organizations looking to hire telephonic nurses. It shows you have "corporate" or administrative strengths that are essential for those positions. If you want to get into CM, you can tell potential employers your goal is to become CCM certified. I was certified in CCM 5 years ago and at that time a 4 year degree in Healthcare was not a requirement, but employment in the field was. I was also hired by United Health Care without any CM experience, but 3 years Med Surg and 10 of healthcare. I worked as a telephonic RN for 5 years and it was my healthcare background that made me successful at that type of position. Also, don't shy away from jobs that post CCM required. It is definitely becoming the gold standard, but I work at 2 Acute Care hospitals as a Case Manager and besides myself, only 2 other RNs are CCM certified. Your goal should be to become CCM certified, but still try to apply and interview for any interested job; the interview experience will be helpful and you might end up with obtaining a job you didn't expect!

I am an acute care CM and I work for 2 different hospitals per diem. Each hospital is interpreting the 2 MN rule differently. One hospital is extremely strict and requiring a Medicare Attestation order upon admission, as well as documentation in the H&P clearly stating why this patient is expected to stay in the hospital for 2 midnights. If these 2 components are not met, the physicians are contacted by the CM to complete these in the medical record. They were not happy at first, but are starting to come on board. The other hospital I work at is the complete opposite. They are interpreting the 2 MN rule completely differently. They are just expecting everyone to be inpatient if they stay 2 midnights, but I think that hospital will be in trouble when the RACs come around!

Hi, I'm interested in similar experiences where a family refuses the bed offer for a particular SNF. We always ask for 3 choices from families and place referrals. Often times a bed is offered at one of the choices, but the family refuses to be discharged because they want to "wait" until a bed is ready at the SNF of their first choice. Is there a Medicare regulation that says a family must accept the first bed offer within 20 miles? Someone mentioned this reg recently, but I'm not aware of it. Also, are any CMs handing out notices to patients when they are admitted to OBS and NOT Inpatient? We have yet to do this at our facility. It seems at our facility, the patients "rule to roost". Thanks for any input.

Hi I had a question regarding switching from Obs to Inpt. In my previous experience, the physician was the only one who could make this change. In my new position, the CM notifies Admitting to make the change from Obs to Inpt if it's been more than 24hrs and the patient is not planned to be discharged. I wasn't sure if it's out of a CM's scope to change that status without notifiying the MD as this wasn't my practice in the past. Any thoughts?

Thanks for the suggestion. I just started this month and was told they are planning to get Interqual sometime this year. The CMs do both UR and discharge planning. So far I find the most challenging thing the Inpatient vs Observation status review since there is no guidelines. We just look in the chart/computer for consults and document data and then participate in rounds with the MDs for updates. They mentioned interqual in my Interview, but another CM said it will take up to a year to get it. I will certainly check out the references you mentioned.

I'm a new Hospital Case Manager and my facility does not use Interqual or Millman as a guide when determining Inpatient Vs Outpatient status. It's all "clinical judgement" at this point, and being new to this position, I'm struggling in this area. I know if your hospital subscribes to Interqual, you can obtain a manual. Since mine does not, does anyone know where I can obtain a manual or a similar resource to assist with the criteria? Thanks so much for any suggestions.

I know exactly what you mean about feeling dumb with the docs. I never had a problem calling docs when I was a nurse on the acute care floor, and I have a lot of personal experience dealing with docs 1:1. But for some reason last week, I felt tounge tied and completely lost all confidence! I honestly think the more you work, the more comfortable you will become. I'm only per diem, so I will have a difficult time coming up to speed, but I signed up to work every weekend once I'm off orientation, so I'm forcing myself to get right in there and learn the job! Good luck!

I just started a new job as a Hospital Case Manager this week. I have both Acute Care experience and Case Management experience for an insurance company. Both are helpful, but I don't have any direct inpatient case management experience. I was a bit overwhelmed as well, but I think with time and patience it will all work out. There is so much to learn and the only way to learn it is to experience it. I think what is most important is being able to prioritize your work and making sure the patient has everything he/she needs as they progress through their admission. I'm approaching my responsibilities the same way I did for my floor assignment, and at the core is the nursing process. Maybe you could apply this process to your previous experience. I'm also expecting it's going to take at least a couple months to feel comfortable. I'm open to suggestions as well!

I also worked for UHC for 5 years as a work at home CM/DM Case Manager. I loved it and the only reason I left was to have a baby and become a full time mom instead. I worked with an amazing group of nurses, always felt supported and I walked away from that job as a CCM, which is now opening doors for me as I am going back to work per diem. In fact, I had an interview last week with a Hospital for a weekend Per Diem Case Manager. I don't have any experience in this area at all, but what got me through the door was my CCM. If UHC did not push me to obtain this certification, I would never have done it. It's excellent experience, a great learning opportunity and very rewarding. However, if you are a person that does not like to work independently, think hard before taking it. There are no lunch or coffee breaks with other people. Also, it's hard to "break away" from the computer at times and you'll find yourself signing on to it on weekends just to see what's going on with work.. I will say though I did form friendships over IM and the phone with RNs on my team in different states and we still keep in touch even though I left. Good luck!

I worked at home as a Telephonic Case Manager for UHC for 5 years and absolutely loved it. It was challenging, rewarding, and a little boring at times, but I loved it. I only left because I had a baby and wasn't planning on going back full time. If you like to be around people at work, it can feel very isolating to be at home. However, all the members on your team work from home, so you build "cyber" work relationships and feel very supported. I will tell you even though it's "work from home", you are expected to be at your desk working and your activity and production is tracked and monitored and there are certain metrics you must meet. You will feel chained to a desk even though you are working from home. At times you won't feel like a nurse, so you have to be open to working in a "business model" and you have to be comfortable with a dual role of nurse and insurance company employee. My first job was for a national Insurance Company, so it was a perfect fit for me. If you want more specifics please feel free to email me at [email protected]. Good luck.

Great point! Thanks so much. I need to get used to charting in homecare, as opposed to charting by exception in the hospital. I'll take all the pointers I can get!

Thank you both so much. I did reach out to the RT who did a Vent inservice for me and he said some patients can find manual bagging a relief to anxiety. He said he would only do it for 2-3 minutes and then put the patient back on the Vent. I do think in this case it is a ritual/control issue as you both mentioned and I am definitley going to practice with the family and orienting nurse so I can improve my skills and be effective with this intervention. I also like the idea of monitoring his pulse ox/heart rate and since he is cognitively aware, he should be able to let me know how effective I am. This is my first Vent case, so I'm a little nervous, but at the same time viewing this as a challenging assignment with the opportunity to learn new skills! I appreciate the support and suggestions and will try them on my next shift! Thank you:)

I recently oriented on a case for an adult who is on a vent. I was told that he periodically gets anxious and asks the nurse to manually bag him for long periods of time. The nurse orienting me said all the nurses on the case will bag him for short periods of time until he calms down. I asked the nurse to demonstrate this for me, and she showed me how she bags the patient. The patient was happy to let the nurse show me, and she bagged him while he sat at a table working on a puzzle. I've only manually bagged trach patients prior to suctioning, and they were lying down. This is my first vent case and as I was trying to take over bagging for a few minutes to get the feel, and it was a bit awkward bagging someone sitting in a chair. I was also not hearing an "expiration" from the bag when I was bagging, but the orienting nurse said I should hear this sound if I am bagging correctly. No matter how I held the bag or squeezed the bag, I didn't hear any type of expiration back through the bag. My question is, is it common for Vented patients to come off the vent and be manually bagged as a way to calm anxiety? They do give him PRN meds for his anxiety, but I was not expecting to be bagging a vented patient PRN. I certainly expected to bag in an emergent situation. Am I totally green in this area, or should I run this by an RT? Thanks for any help you can offer.

I completely applaud ventmommy and would take a case in her home any day. I am an RN and the mother of a child with complex medical needs receiving 70 hrs/week of private duty nursing. I have exceptional nurses who not only respect their profession, but respect my home and my family. I have never asked the nurses to do laundry; they have offered. Not because they are bored, but because they are dedicated to providing exceptional care to my daughter and exceptional support to our family. If you are working in home care and expecting similar "shift" work as a hospital setting, you are doing a disservice to yourself and the home care patients you care for. As an RN, I strive to meet the all the needs of my patients and if a mother wants me to fold her laundry or put away dishes or mop her floor, I would do so in a minute. I would do this not because I think it is a "nursing" responsibility, but this is what the family and child need at the moment. Home care nurses need to realize the family needs are also the child's needs. At the end of the day, as an RN I know I am making a difference in the child's life by providing excellent nursing care and supporting their family as well. As a mom, I must be doing something right because I have had the same staff of homecare nurses for 5 years and several more looking for the opportunity to work in my home. I wouldn't want any nurse working in my home and caring for my daughter if she equates doing laundry with maid service.