RN Case Manager? What does this mean in Home Health?

Nurse on the Go · Jun 6, 2018

Hi! Home Health Case Managers do indeed provide direct patient care. They oversee all aspects of the patient's home health services. That includes things like creating and updating the patient's plan of care, determining an appropriate visit frequency, communicating with the MD, ordering/obtaining necessary supplies, tracking all the OASIS timepoints and completing assessments, facilitating referrals within the interdisciplinary team (PT, OT, MSW, etc.) The number of patients you will be expected to case manage may vary by agency, but from what I've seen it's typically between 25-30 for a full time RN.

Patients are usually seen between 1 and 3 times per week (it will vary based on what the patient needs, some may be seen less frequently if you're just doing catheter changes for instance.) You will generally do their OASIS visits like you mentioned above and delegate the follow up visits to your LPN. The LPN will communicate any changes in the patient's condition or new needs the patient may have, and you'll work with the MD or the interdisciplinary team to figure out how to solve the problem.

In the agency's where I've worked, all RNs are considered Case Managers, except when we've had nurses who only worked a few days a week and primarily did SOCs to hand off to a Case Manager.

As far as challenges, there is a fairly significant administrative/paperwork component, and that piece is not for everyone. Home Health is heavily regulated by CMS and that comes with it's share of challenges- it's a steep learning curve. The things I see new nurses struggle with the most are staying on top of documentation and effectively managing their time to get everything done within an 8-hour day. Strong organizational skills, time management and prioritization, and critical thinking skills are an absolute must. It also helps if you have a strong office-based support system (manager, triage nurse, scheduler, etc.) who have your back and can help you with questions and some of your admin tasks when needed.

Is it worth it? In my opinion, absolutely! I love home health and don't see myself working in any other setting for the foreseeable future. I love the autonomy, the 1:1 time with patients, the ability to see the same patients and watch them progress and heal over time.

You can definitely advance your career in Home Health if you're so inclined. Here's my story from a previous post: I started out as a field clinician/case manager in a small agency and later worked my way up into an office-based nursing position. Over time, I cross trained to do several different types of roles: intake/transitional care, utilization management, triage, even a little bit of billing. I really got to learn home health inside and out! I found it was always just a matter of putting myself out there and volunteering to learn and do more. Now I'm a manager for a large hospital-based home health agency. I can attest that there is definitely opportunity if you stay hungry! If management is not your ultimate goal, there are plenty of ways to advance clinically as well. I know several nurses who have gone on to become certified in wound care, nurses who have moved into education-focused roles, and I even have a nurse right now who is working on an ARNP degree.

Hopefully this was helpful to you. I wish you all the best in making your decision!

caliotter3 · Jun 6, 2018

Job responsibilities of the case manager depend upon the policies of the individual agency. It would be best to speak to the Director about job expectations.

Libby1987 · Jun 6, 2018

Hi! Home Health Case Managers do indeed provide direct patient care. They oversee all aspects of the patient's home health services. That includes things like creating and updating the patient's plan of care, determining an appropriate visit frequency, communicating with the MD, ordering/obtaining necessary supplies, tracking all the OASIS timepoints and completing assessments, facilitating referrals within the interdisciplinary team (PT, OT, MSW, etc.) The number of patients you will be expected to case manage may vary by agency, but from what I've seen it's typically between 25-30 for a full time RN.
Patients are usually seen between 1 and 3 times per week (it will vary based on what the patient needs, some may be seen less frequently if you're just doing catheter changes for instance.) You will generally do their OASIS visits like you mentioned above and delegate the follow up visits to your LPN. The LPN will communicate any changes in the patient's condition or new needs the patient may have, and you'll work with the MD or the interdisciplinary team to figure out how to solve the problem.
In the agency's where I've worked, all RNs are considered Case Managers, except when we've had nurses who only worked a few days a week and primarily did SOCs to hand off to a Case Manager.
As far as challenges, there is a fairly significant administrative/paperwork component, and that piece is not for everyone. Home Health is heavily regulated by CMS and that comes with it's share of challenges- it's a steep learning curve. The things I see new nurses struggle with the most are staying on top of documentation and effectively managing their time to get everything done within an 8-hour day. Strong organizational skills, time management and prioritization, and critical thinking skills are an absolute must. It also helps if you have a strong office-based support system (manager, triage nurse, scheduler, etc.) who have your back and can help you with questions and some of your admin tasks when needed.
Is it worth it? In my opinion, absolutely! I love home health and don't see myself working in any other setting for the foreseeable future. I love the autonomy, the 1:1 time with patients, the ability to see the same patients and watch them progress and heal over time.
You can definitely advance your career in Home Health if you're so inclined. Here's my story from a previous post: I started out as a field clinician/case manager in a small agency and later worked my way up into an office-based nursing position. Over time, I cross trained to do several different types of roles: intake/transitional care, utilization management, triage, even a little bit of billing. I really got to learn home health inside and out! I found it was always just a matter of putting myself out there and volunteering to learn and do more. Now I'm a manager for a large hospital-based home health agency. I can attest that there is definitely opportunity if you stay hungry! If management is not your ultimate goal, there are plenty of ways to advance clinically as well. I know several nurses who have gone on to become certified in wound care, nurses who have moved into education-focused roles, and I even have a nurse right now who is working on an ARNP degree.
Hopefully this was helpful to you. I wish you all the best in making your decision!

Fantastic description!

CardiacRNLA, BSN · Jun 6, 2018

Thank you so much! This was really informative. I like the flexibility and freedom. But I am worried about the autonomy lol. There are certain clinical conditions I don't have much experience with. Also I have been out of the workplace for 8 months and takes a bit to get back into "nurse mode." I have read the forums and it seems like new HH nurses are working extremely long days to start. I don't want to be working 50 hours+ a week. I have a lot to consider. The position I have been offered is full-time. Is it reasonable to ask to shadow or for per-diem? I need to get back to work but I don't want to fail.

Do you know anything about Encompass Health? That's the agency. Again, thanks so much!

Libby1987 · Jun 7, 2018

Thank you so much! This was really informative. I like the flexibility and freedom. But I am worried about the autonomy lol. There are certain clinical conditions I don't have much experience with. Also I have been out of the workplace for 8 months and takes a bit to get back into "nurse mode." I have read the forums and it seems like new HH nurses are working extremely long days to start. I don't want to be working 50 hours+ a week. I have a lot to consider. The position I have been offered is full-time. Is it reasonable to ask to shadow or for per-diem? I need to get back to work but I don't want to fail.
Do you know anything about Encompass Health? That's the agency. Again, thanks so much!

A ride-along (home health shadow) is common and is often encouraged. We wouldn't hire a clinician without home health experience without a ride-along.