What makes a good nurse case manager?

[Inori, BSN, RN]

Hello all!

I'm trying to see what makes a good case managers. I hear all the time how so and so is good and what not but what exactly is in this receipe of a good case manager?

personality, skill sets, clinical specialty, certifications etc.

Thank you!!

[L8RRN]

It really depends on the type case management. I'll just comment with my opinion on the roles I have participated in as a CM:

Utilization review: STRONG medical knowledge, knowledge of insurance rules and admission criteria.

Discharge planning: Strong people skills, great organization and time management skills, strong knowledge of insurance rules and community resources.

Home Health: Good hands-on nursing skills (assessment, wound care, PICC care, IV administration, etc), ability to improvise, and good documentation skills.

There are more but I don't want to comment on ones I have no direct knowledge about. :)

[Inori, BSN, RN]

what type of case management is this? in clinic

Description: when case manager nurse collaborates with PCP, follows patients, every 2-3 weeks, teach pts self management to reach their medical goals (HTN, DM etc), assesses barriers to care and refers them to resources and reminds/ensures they are following up with thier PCP and works with PCP in adjusting medications as needed.

[L8RRN]

I don't have experience as that type of CM. It may be in clinic or may be with an insurance company. Some insurance companies use case managers to help coordinate care for chronic conditions (like those you listed above) to help with compliance and better health outcomes.

[d'cm]

This is a good question. I would have to say that what makes a good CM might depend on who is asking. Employers may think what makes a good CM is one who maximizes their revenue, C(their)A, and completes all tasks correctly. However the CM who truly advocates for their patient is often at odds with the profit motivations of the employer. The good CM knows how to walk that fence. The good CM also has the ability to anticipate problems and plan accordingly. This comes with experience as it involves knowing the limitations of providers and patients and knowing where things are likely to go wrong. The good CM confirms and follows up, confirms and follows up.

[nurseprnRN, BSN, RN]

Worker's comp:

Excellent knowledge of WC laws and regs in your area of responsibility

Really good file of the best docs for care in many specialties, or a bunch of colleagues who will share theirs-- and of the really bad ones to be avoided

Good teaching skills, to teach insurance adjusters, injured workers, and employers about what's important in recovery from an injury, medications, treatment plans, and keep them communicating well c each other

Excellent writing skills, for all the letters to providers, lawyers, and employers you're gonna write, and your monthly reports

And my early mentors always told me that it was really important to call the office right away if I saw a good sale while I was out driving around to appointments, so they could get out there too.

[Paul B]

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.

[Joe NightingMale, MSN, RN]

I'd say organizational skill is #1, and then problem-solving is #2. At least for insurance company discharge planning.

[KbmRN, ADN]

Inori I believe that is RN Case and Disease Management. I did that telephonically for a while, but also met the pts weekly for their assessments.

[RN010101]

Thank you all for the great advice. I'm a new CM, and I'm learning a lot through this thread.

[bok2012]

I work in a busy emergency department. I would say the number one skill needed for my position is problem solving, followed closely by thick skin.