Work From Home: Nurse Case Manager

[Melissa Mills]

Many nurses have the dream of working from home. But, how?

There are several different types of work at home nurse positions. One of the most common work from home nursing positions is a nurse case manager. Case managers work for insurance companies, hospitals, home care, hospice and managed care organizations to name a few.

Some nurse case manager positions are a combination of work from home and onsite duties. While others are 100% work from home, telephonic positions. Each individual type of case manager will have specific job duties based on the industry and type of patient or client.

There are specific tasks or duties that all case management positions will complete:

Caseload Management

Case managers have a caseload of clients to manage. Average caseload size varies depending on the industry and acuity of patients.

Managing a caseload of clients includes managing the flux of admissions, discharges and changes in care that requires revisions to the case management plan. You will likely have an average daily production or number of visits or calls you will need make each day. At first, managing a large number of cases over months or even years may seem overwhelming. Over time, you will become more comfortable with the art of caseload management.

Conduct Assessments

All nurses who provide care or services to patients conduct assessments. Working in a telephonic environment is certainly no different. Conducting assessments over the phone can be challenging. You have only one sense to rely upon, your hearing. You must become very attuned not only to what the patient or client says, but how they say it.

Just as nurses in hands-on care positions, you will collect a health history, medication assessment and create a list of current problems. With each assessment, the case manager uses critical thinking and clinical skills to ensure the patient receives the education needed to make sound health decisions.

Care Coordination

All case managers assist their patients with coordination of care or services. You will be assessing the patient's primary care needs, education needs and the need for other support services. You will become familiar with providers within the client's service area. If you would for an insurer, you will likely need to have working knowledge of their policies and products so that you can easily coordinate covered and noncovered services.

Patient Advocate

Nurses advocate for their patients.The role of the case manager can oftentimes come with a few tricks in the department of advocacy. For example, if you feel that a patient needs to have an MRI of their shoulder, but the insurance company does not cover this test, how should you proceed when you work for the insurance company? Do you advocate for the patient and attempt to get the test approved? Do you advocate for your employer and simply accept that the test is not covered?

This can be a tough situation for case managers to navigate. A general rule of thumb is to always advocate on the behalf of the patient. Even if services are not readily available, there will be a way to get the patient the care they need. You may have to reevaluate the situation and brainstorm for another answer.

Create and Update a Case Management Plan

The Case Management Plan is a tool. This tool helps you to collaborate with the patient to create goals they want and need to accomplish. The means by which the goals are achieved are interventions. The interventions will likely be items that both you, as the case manager and the patient will need to complete in order to meet the goals.

As the patient achieves goals, you will create new goals. Most case management plans will have specific types of goals required base on the industry or specialty of the patients' needs. For example, if you work with injured workers, you will always create a goal specific to their plan to return to work. If you work with diabetics, you will likely have a goal that is specific to their medication management and daily glucose monitoring.

Case Managers may not provide direct hands-on care, however, they are performing nursing tasks. They use their nursing knowledge to assess the patient's needs and create a plan. They work one on one for longer periods of time with their clients to achieve better overall health outcomes.

If you think that case management may be for you, research the role of case managers. Below is a list of resources to learn more:

• CMSA Home - Case Management Society of America
• ACMA : American Case Management Association
• Commission for Case Manager Certification (CCMC)

[shamrokks, ADN, ASN, RN]

I transitioned from the floor into case management in March 2018. It is a lot different but I like it more and more as I go along. I work from home 4 days and in the office 1 day a week. It is a blessing. My pay basically stayed the same but I am no longer night shift and off all weekends and holidays plus my PTO base is better because at the hospital my base rate was lower.

[BlueeyesRN]

Melissa,

Nurse Beth directed me to your article. Thank you and for the comments from other nurses. I just started applying in earnest but lost out on a UM/CM position.

My background is both as a RN,BSN 13 years (rehabilitation, HHC, 1 year school nursing) and licensed PT assistant (PTA) for 26 years. I never fully gave up on PT and did both in HHC though I burned out on the RN side doing OASIS- I was a case manager too. For the past 6 years, as an RN, I have worked prn as a private duty for post surgical patients though mostly as a PTA. I like the one-on-one and my pts often request me when services are needed again.

I also worked previously at one of the top 20 Rehabilitation hospital 2 years in TBI and orthopedics. I hope my dual roles do not confuse recruiters.

Though working now more as a PTA in HH, last year I helped determine something was wrong with a patient (was pleural effusion) The cardiologist and HH nurse did not see a connection. He had a CABG. During PT I noted HTN + mod SOB w/ limited ambulation, dropping SpO2. He was on O2 since at a SNF "PT put him on it" due to SOB. I was seeing him at 3 months post CABG. I called cardiologist and HH nurse 3 occasions per protocol w/ high BP, SOB + lower Sp02. Nothing changed. I asked the pt to see a pulmonologist after no Hx of COPD and he had not been a smoker for 35 years. **I still use my nursing skills**

For those that wonder why I chose the work options, I have a disabled son w/ autism and he had been a hand full at times. He is an adult (sad reality) going into a group home soon. I need money, benefits, and have a passion for my patients.

1. What type of RN case manager job would appreciate my skills in rehabilitation, geriatric (all disease, Ortho, and Neuro) + familiarity w/ Medicare, Medicaid, HHC, SNF?

2. What can I emphasize in word/ person though I work prn private duty nursing assignments and do mostly HH PT work? I am calling my RN work prn or part time.

3. Best companies to apply that have fair quotas, training? Best benefits? Avoid what companies? I realize this is subjective.

4. Please direct me to some good CM CE classes and books.

I want to learn and grow. I do not mind working onsite 1 year as CM/UM in office and have a preference working from home.

Thank you!

[Loved Nurse]

I would love to become an NCM..