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Paul B

Paul B

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  1. Paul B

    What makes a good nurse case manager?

    Although a good case manager must be clinically strong and knowledgeable about the required "data"...a really good case manager has excellent communication and time management skills...the rest can be learned over time. I think it is important that case managers hone their communication skills - motivational interviewing skills, critical thinking skills, problem solving skills. Without these skills, all the pragmatic knowledge will get you nowhere. Oftentimes a good course can help to develop these skills. Consider these skills when evaluating the course you choose.
  2. I would recommend going to some of the career and job websites - and looking at the descriptions of the CM role and qualifications. This will give you a good overview of a variety of CM jobs - their environment, their specific duties, etc. I would also consider whether you want to work on a provider vs. a payer side. If you really want a job in case management - consider taking a certificate of certification course - this will help you to understand this new career path you are considering and will also give you an advantage when applying for a job. Some people even consider getting a case management certification - you can find such info by doing a search using some of these keywords - qualified case manager certification RN. hope this helps.
  3. Paul B

    Peer to peer

    Be sure to include this type of discussion with your Physician Advisor - they are your best resource when having communication issues with a specific MD.
  4. Paul B

    new case manager

    Oftentimes, ER patients do not have insurance - this is why they come into the ER in the first place. The most important aspect of ER case management is to determine if the patient actually needs hospitalization or a referral to community services. A good ER Case Manager is a wealth of information about their specific community and who or what is available. It is also important to remember that some ER patients are drug seeking and one must have excellent skills and team communication to identify who needs help and who needs boundaries. This is one of the most comprehensive CM jobs around. Be sure to maintain a team approach - and include the physicians in all discussion of psycho-social issues.
  5. Paul B

    interqual training

    Generally, it is true. Utilization Review Criteria is kept proprietary and thus their training only offered to those that already have a job in their specific facility. But I have found two exceptions. There are some staffing agencies (in California I believe) that have arrangements with their local hospitals, to provide direct UR training, even though they are not direct employees of the hospital. I also found one course that is brief but generated by MCG...I think you can do a search on "mcg utilization review course". This course uses direct reference to the MCG software. It is not comprehensive but it is a good introduction.
  6. Paul B

    Learning Interqual

    I truly believe that learning the nuts and bolts of Utilization Review is easy...but learning how the real person (patient AND family) fits into a computer program is something that takes more time and experience. I have used both Interqual and Milliman (MCG) - I find Milliman to be more "holistic". Don't expect yourself to be an instant expert. And, don't forget that doing a comprehensive review take time...be committed to doing a complete review rather than trying to rush through...everyone will benefit.
  7. Paul B

    Considering Nurse Review position

    Nurse Review positions can also involve what is called "Onsite Review" which means you have your case load and you go to the hospital to review these patients' charts and if necessary speak with applicable and related healthcare professionals on each case - including the hosp cm. This can be a very interesting job - you have the ability to truly help with discharge planning - and evaluate each patient from a more holistic perspective.
  8. It is always impotant to maintain your work-life balance...this is obvious but not always easy to do. One must learn skilled and diplomatic ways to maintain your own boundaries. Many companies will pay employers a "SALARY" so they don't have to pay overtime. I have had multiple positions as a Work Comp Case Manager and not one of them expected me to ONLY work 40 hours. It was very difficult to fulfill my job duties while still keeping my overtime to a reasonable amt. It is hard to see what a job will expect - but I do recommend getting as much information in mind when considering a new position such as one as a Workers Comp CM.
  9. Paul B

    New WC CM Nurse

    A great deal of the workers compensation RN position is to advocate for the patient. Even though "saving money" has been identified as a purpose of this position - it is much more a position of importance because you are meeting each claimant in their own environment, you are learning about who they are, what their work environment is like, how they relate to their "work", and how their current situation/injury has impacted their life. This position takes a great deal of skill because you are working for your employer but also your claimant, the physician(s), the rehab professionals, the adjusters, etc. Being in a position that requires such a holistic perspective demands you can be a great advocate and an expert communicator. I hope you are beginning to see this is not just a position that requires "secretarial" skills... As noted earlier, experience in this field provides more opportunity to gain wisdom and insight into the ways you can make a difference...and not merely a monetary difference. The meaning of work in a person's life is of monumental importance...keep this in mind.
  10. Paul B

    interviewing for UR position

    Utilization Review will never be on the chopping block but as you mentioned it may be merged into a more comprehensive role that includes discharge planning, etc. Utilization Review is the foundation of the healthcare reimbursement system. It is not going away. This is an excellent pathway into other types of case management in the future. I wouldn't worry about the availability of this job. Learn all that you can and your future options will only be improved upon.
  11. Paul B

    Case Management Scenario Questions

    Scenarios are a good way to understand the intricacies of case management. I would conclude that an interviewer who is asking you about this level of understanding of case management - is probably assuming you already have experience in case management. But - to address your questions: In response to scenario 1: It is unclear how you received this case. Was it from an adjuster? If not then who? I am not clear about what led you to believe this was not a work related injury. Cases are not sent to a case manager in a work comp setting unless they have been reported by the employee to the employer and then the employer alerts their insurance carrier. This scenario is very lacking in enough detail to truly provide an informed answer. It is not up to the Case Manager to make a diagnosis or determine if an injury is work related. In regards to Scenario 2: I generally agree with the answer submitted which refers to "Attorney Smith". I agree with the additional information for the claimant reminding him/her that the attorney works for the claimant - not the other way around. Generally speaking you can communicate with the claimant via mail (sent to the attorney) - just not in person or directly via telephone. Each state's workers comp laws are unique. It is important to understand your state's guidelines in this matter. Oftentimes, a claimant does not understand the role of the case manager. This information would be important to offer to the claimant in an acceptable format/venue/etc. so the claimant can make an informed decision. And lastly, it is always important to document, document, document. 2) "I'm sorry, but Attorney Smith says I can't talk to you. When he gives permission I would be happy to work with you. Please tell him you called me. Remember, he works for you, you don't work for him." Document these calls and report to adjuster, too.
  12. InterQual fails to see the value in training employees of NON-PAYING customers, even though it benefits their PAYING customers in the long run.
  13. CPHM Program Agenda -- see for yourself what is covered -- I don't see the word InterQual anywhere . . . or Case Management for that matter. CPHM Program Agenda | McKesson
  14. P.S. McKesson's CPHM "certification" does not teach students how to use InterQual
  15. Being the tenacious CM investigator that I am . . . here is an FAQ page on the McKesson website: InterQual Education and Training FAQ's | McKesson that describes WHO InterQual offers training for and it is NOT to individuals -- What type of training is offered? McKesson offers Web-based high-level software navigation, system access and security settings courses for our technology customers, training for criteria-only customers, and onsite training for criteria and technology customers.
  16. I followed these links and never found an InterQual course that I could sign up for. I did see that they had a phone number listed, but no matter how many times I called, I only got a recording. I'm fairly sure that all the courses that are listed are only for employees who already work for a company that has purchased the InterQual software -- NOT individuals looking to learn about it who are not currently employed by a paying customer of McKesson / InterQual. I would love to be wrong about this, but it is what I have experienced in my search to learn about InterQual Criteria.