Hi there, I'm looking for some feedback and suggestions.
I'm currently a psychotherapist (MSW) and will be starting a nursing program in January. I work in a non profit substance abuse treatment center (outpatient, residential treatment, and medical detox services). Through my time there, I have been able to identify needs this agency has for client care. They currently do not accept insurance, but with the funding limitations we are starting to experience (South Florida area. We're being managed by a for profit managing entity now, as are all other publicly funded agencies) there is a need to start accepting insurance in order to increase funding streams available. This managing entity is increasing their focus on discharge and aftercare planning (even though the M.E. has pretty much tied our hands on how we can discharge plan with our clients, but that's another story entirely) and is causing a lot of changes in how we approach every level of care. My employer and I will be sitting down in the coming weeks to discuss how I can utilize my current skills and increasing knowledge in the nursing field with their needs. Since we don't currently have utilization review or case management/discharge planning departments, my aim is to work on opening up one if not both of these departments.
My questions are as follows:
1- What nuances should I be aware of to present during this conversation which will help or would be necessary to make either department successful?
2- What software would the agency need to utilize in order to have a level playing field with the insurance companies/managing entity? We're public funded so think along the lines of DCF, courts, dept. of corrections, etc...
3- What would be a reasonable pay request? Something to keep in mind, my agency underpays for the field, so I couldn't ask for what would be normal in a hospital setting.
Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr.
Separating administrative from professional realms is perfectly possible and often advisable.
No, I agree with you. I was talking about legally. The OP can run the department, but he/she will need to hire a nurse for the nurses to answer to directly regarding nursing practice, at least in the States I hold a license.
Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr.
I doubt my agency would pay what an experienced case management nurse could command in this field.[/Quote]
So, once upon a time (prior to nursing) I worked for an agency that had many social and psychiatric services to include a chemical dependency clinic and residential program. Anyway, long story short, the owners and BOD wanted to save money. They had a UR/UM department originally run by a person with no degree at all, who later got a degree in social work. She hired non-nurses to perform UM/UR under the impression that nurses were not necessary. Long story short, she was eventually fired.
The agency we worked for got tired of being fined often and heavily by the state for the poor billing practices and incompetency of that department. Long story short, they replaced her with a very well paid Registered Nurse who hired competent nursing staff because they saved money doing so (Fines add up to several hundreds of thousands and possibly millions over time). Good luck to your company and you. :)
SummerGarden, BSN, MSN, RN
3,376 Posts
No, I agree with you. I was talking about legally. The OP can run the department, but he/she will need to hire a nurse for the nurses to answer to directly regarding nursing practice, at least in the States I hold a license.