Yeah! I got my first CM Job!!!

Mijourney · Aug 3, 2008

Congratulation Lisa! Even though I've never done hospital CM, it's all tough to me. What you want to make sure is that you know and understand your role(s) thoroughly and learn how not to cross the line in getting your clients what they need or want. You'll have dozens of roles you'll have to play as a CM, some at one time. I wish you much success in your CM position.

Itshamrtym · Aug 9, 2008

FINALLY! I got my first CM job in a hospital setting. I can't wait to start. I've wanted this for so long. My current employer requires a three week notice, so I will start after that, but I can't wait. I asked the CM Director if she had anything I could "study" in the meantime before I start and she's working on that. I just want a great start. What is the toughest area to learn when starting out? I would think it's just learning what all the insurance companies allow/require, but I could be wrong on that. Any suggestions? Thanks!!

Congrats on the new job!!!!! You should love it!!! :yeah: :yeah: :yeah: :yeah: :yeah:

IngyRN · Aug 9, 2008

1) Medicare rules-for the most part, they will not make any sense-don't try to understand them just memorize them. Sometimes this will pose one of your biggest barriers to getting patients placed and meeting their dc needs.

2) Medicaid rules and reimbursement- they either pay for all or offer VERY MINIMAL reimbursement-some providers will not accept it due to this.

3)Commercial insurances-they have specific participating providers and reimbursements-you will become familiar with those who are common in your area.

4) If you are doing utilization review also-find out which criteria your hospital uses to determine hospital level of care. Most common ones are Interqual, Millman & Robinson. etc. You will become VERY familiar with this-it will be your Bible.

5) Become familiar with the pt demographic which you will be working with. IE if you are working w/geriatric population-know that most will have social issues, many will need nursing home or rehab placements or homecare. Important things to consider with this population- what is their current home situation, do they have support system, how safe is their ambulation-they can decline rapidly. Get a PT eval as soon as you feel pt may need to give you a sense of pt safety. Will the pt need Meals on wheels, other community rsources. Get Family involved from day 1.

If you are are working on a surgical or specialy unit like oncology-know the common dx and anticipate their potential needs on admission-start working to get your dc plan in motion ASAP. For example: if common procedure is colectomy w/colostomy-make sure pt is getting colostomy teaching as soon as appropriate. Anticipate need for services and referral to wound care nurse ( of course this is facility specific), if you are on an oncology floor-know that pt may need homecare for post chemo assessment,line care for central lines, iv infusion/ivf at home, social service support.

ALWAYS involve the pt & family (unless directed not to by pt) in dc planning.

ALWAYS have a d/c plan on admission-this may change but if you assess pt situation and anticipate needs you on course. You DO NOT want a D/C to de delayed due to poor dc planning ( your boss may not appreciate that) Of course sometimes this is inevitable

6) Be prepared to deal with difficult pt & families. Sometimes they love you. Many times you are the bearer of BAD news-ie Mrs Smith, you need a nursing home, mr jones, your insurance will not cover that medication , mrs X- I realize that you would like to stay here another 2weeks because you like the food here but your MD has discharged you, and your insurance company will not pay for you to stay here because you do not meet hospital level of care.

7) Sometimes you are the case manager, the dc planner, the insurance's reporter, pt advocate, RN, social worker,educator, community resource person, inverstigator,the roles go on & on & on & on.

8) There is soooo much information that you will learn as you go along. many peple this this is a cushy job-it is very challenging at times. But when you meet the pt's dc needs-especially those difficult ones-you feel a great sense of accomplishment.

Please let me know how else I can help. best of luck and congratulations.

snotpikkr · Aug 9, 2008

Congratulations! What I tell my staff- No one dies because of the paperwork you do. Your job is never done in a day. When it's time to go home, you need to go home. Being a Case Manager is stressful enough without adding unnecessary stress to yourself. I've been in hospital based CM for over 20 years and came as a new nurse with a pen. Now using computers is a big help. Know your clinical area you'll be assigned to. It helps. Enjoy and keep us posted.

QueenAngie · Aug 10, 2008

Congrats on your new position!

I was a CM in a hospital for 10 years. Included Utilization Review, Discharge Planning, Coordination of Care, Quality Monitoring, and more.

M&R and Interqual will become your two favorite lines of reading. You will come to memorize them, only to have them change again next year.

Will you be using laptops or

pen & paper?

Best of luck!

lisa41rn · Sep 2, 2008

Thanks for all your repsonses. I reallly appreciate it. I just finished the first day of my job and it went well. I'm exhausted though! Too much "stuff" to remember, but in a way it didn't seem too bad; the tougher patients are to come, I'm sure. I can't wait to get passed the initial training period as it can get boring at times. I just want to dig my hands in, if you all know what I mean! The majority of the work is done on computer. The docs still write orders/progress notes on paper; otherwise all info is on computer. Love that!

seasoned rn · Sep 13, 2008

How's everything going on your new job?

lisa41rn · Sep 13, 2008

I've completed nine days and it has been wonderful. BUT, I was forewarned there is a lot to learn and my mind is spinning. The beginning of the week I starting taking half the floor and the CM training me said I was doing great as many can't handle that many patients so soon. It wasn't always perfect; I made minor mistakes, but I've learned from them. It is hard having a zillion rules/directions thrown at you and you are expected to remember it all. My "preceptor" was very nice, but it went through me when she'd say "Remember this morning when we were talking about......." as if I was dumb to ask again, hours or days later.

Anyway, this week I'll be working a day or two on other floors with different CMs. I've heard disaster stories about one of them and it makes me kind of nervous. She apparently is very smart, but quite mean. In fact she has belittled patients who are overweight/obese, smokers; issues where they have illnesses possibly brought on by their own bad habits. Apparently one patient was left devastated by the way this CM treated her. She has gotten into shouting matches with coworkers, etc. I just don't understand why employees are kept on like this, regardless of how much they know. During orientation just three weeks ago the hospital did a presentation on customer service and treating others with respect stating it was required. Somehow this CM acts as she wants and gets away with it. Makes you wonder.

Anyway, I really love my work, can't wait to figure out and remember the main "rules" and also come to know the nurses and doctors. The latter has been a big issue. I'll get there! Thanks for asking.

seasoned rn · Sep 13, 2008

Well I'm glad everything's going well. I started my first job as a case manager 3 weeks ago at a insurance company as a disease case manager. The first two weeks I felt like I was in Insurance 101. I learned about, claims, appeals, authorizations,etc,. But the third week we started focusing on disease management and it's specific role that I as the nurse would have. I'm so ready to learn more and more. I LOVE IT !!!!