What is the difference between HH Case Manager and hospital/insurance CM?

[MyUserName,RN]

Hi All, I am about to be starting a position as a Case Manager RN with a home health agency. I have two years of acute care experience in a hospital. I'm very interested in case management and home health care, but may eventually want to get into case management in a hospital or for an insurance company way down the road. I know that the home health CM still has direct contact with patients in the home and that the hospital or insurance CM's generally don't do any pt care. What are the other differences between the two? Will my experience as a home health CM be beneficial for the future in other areas of case management? Also, does the experience as a CM with home health qualify you to sit for the certification?

Thanks for any input!

[MyUserName,RN]

Anyone?

[sallyrnrrt, ADN, RN]

you will do admission OASIS, plan and schedule the care over the cert. period, as how many days hha, lvn, therapy comes, you will do recert visits, dischatge visits, and suov. visits......you will prepare case conf. materuals refer to soc worker and other enities as warranted. communicate with physician, write orders, assess wounds, order supplies etc a LOT of direct patient client direct care

[Cupcake24]

I am an insurance case manager, coming from a background of acute care nursing, labor/delivery and then hospice case management. I will tell you; while i am not providing bedside care, I am still providing care to the patients. In the form of advocacy, information, support, guidance etc. What I have found throughout my career transitions between 'specialties' is that: while there are many differences from area to area, there are also many commonalities or threads that tie all these pieces back together on several levels. Yes your HH CM experience will lend towards the qualifications required for CM certification! I just passed my test last month :)

[teriadn2004]

How do you get started on Case Mngt? All the posted jobs want you to have experience or certification? Any ideas? I am particularly interested in Workers Comp.

[sallyrnrrt, ADN, RN]

an absolute easy way to gain experience in case mgt is in home health........RNs are case mgr over their patients care..... do that for a while, guess what you are experienced case mgr

[nurseprnRN, BSN, RN]

In some home health agencies around here, what they call the case manager is the primary nurse that provides the care and writes the nursing orders for the other team members (other RNs, LPNs, CNAs) for a caseload of patients.

Insurance case management generally has zero bedside care component and has just about nothing in common with home health case management, but, as I explain to attorneys all the time, nontelephonic nurse case managers see patients all the time, assess and evaluate them, and create and implement plans of care based on the nursing process while collaborating with the treating providers (physicians, therapists, and others).

Some insurance companies or TPAs (third party administrators, companies that manage the claims when the carrier doesn't want to have a division to do that) are willing to hire RNs with really good clinical backgrounds (especially ICU, neuro, and ortho) for case managers, and they train them in the insurance aspects of the work.

Keep trying. Join CMSA (Case Management Society of America), hook up with the local group, start getting Case In Point mag, you get it with your membership. Attend their meetings and symposia-- you'll learn a lot and you can pick the brains of other WC NCMs you meet there. It's a fun field with a lot of possibilities.

[MauraRN]

an absolute easy way to gain experience in case mgt is in home health........RNs are case mgr over their patients care..... do that for a while, guess what you are experienced case mgr

As an experienced Home Health, Hospice and Home Psych Nurse, let me be crystal clear: THERE IS NOTHING EASY ABOUT HOME CARE!

[sallyrnrrt, ADN, RN]

As an experienced Home Health, Hospice and Home Psych Nurse, let me be crystal clear: THERE IS NOTHING EASY ABOUT HOME CARE!

I did not say home care was easy, in fact nothing about it is easy, what i said was an absolute easy way to gain experience, in case management, is in home health.......we have to be the every thing for every thing, coordinating multi disclipline providers , care plan, case conferance, coordinating with several different physician or adv practice nurse providers in a patients care.......assessments, supervission, recerts etc.......

[MyUserName,RN]

I did not say home care was easy, in fact nothing about it is easy, what i said was an absolute easy way to gain experience, in case management, is in home health.......we have to be the every thing for every thing, coordinating multi disclipline providers , care plan, case conferance, coordinating with several different physician or adv practice nurse providers in a patients care.......assessments, supervission, recerts etc.......

I knew exactly what you meant. I don't expect HH to be easy at all. Floor nursing wasn't easy either and if somebody made a comment like you did about it being an easy way to get started as a new nurse, I wouldn't take it as if working the floor was "easy". I think it's good not to be too sensitive about peoples word choices. Thanks for your info on HH and case management. :)

[MauraRN]

I knew exactly what you meant. I don't expect HH to be easy at all. Floor nursing wasn't easy either and if somebody made a comment like you did about it being an easy way to get started as a new nurse, I wouldn't take it as if working the floor was "easy". I think it's good not to be too sensitive about peoples word choices. Thanks for your info on HH and case management. :)

I am the least sensitive person that I know, at least when it comes to myself. Family, patients etc, that is another issue. Lighten up!!

[MyUserName,RN]

I am the least sensitive person that I know, at least when it comes to myself. Family, patients etc, that is another issue. Lighten up!!

Maybe you should take your own advise hun. :)

I asked what the difference was between CM in HH and in the hospital. I didn't ask how easy or hard HH is or to be told to lighten up when I wasn't even offended and all you could add to this conversation is that HH is not easy. You haven't added anything useful to this conversation, thanks anyways though. Have a good one!