HM5001: Transitioning from Clinical Nurse to Case Manager: A Step by Step Guide 4 Contact Hours TEXTBOOKS: Competency-based Resumes and Competency-based Interviews TAKE THIS COURSE NOW !

OBJECTIVES

1. Define Case Management and explain the philosophy of Case Management
2. Explain the Levels of Care and the difference between payer vs. provider positions in Case Management
3. Discuss the Action Steps required to obtain a position in Case Management
4. Explain the FIVE useful steps designed to help identify, promote and develop one's transferable skills.

OUTLINE

INTRODUCTION

Case Management: A rich history of coordinating care to control costs.

SECTION I

1. What exactly is Case Management?

a. Definition of Case Management

b. Philosophy of Case Management

2. What do Case Managers do? - An Overview

a. Eight Essential Activities with Direct Client Contact

3. Where do Case Managers work?

a. Levels of Care

• Physician’s Office or Hospital Clinic
• Emergency Department
• Observation Care
• Acute Hospital Care
• Telemetry Unit
• Intensive Care
• Specialty Hospital – Long Term Acute Care
• Acute Rehabilitation Unit
• Subacute Rehabilitation/Skilled Nursing Facilities
• Swing Bed
• Home Care
• Nursing Home – Custodial Care

b. Payer vs. Provider

c. Examples of Payer vs. Provider positions

c. Examples of Payer vs. Provider positions

1. Payer Side positions

• Workers Compensation
• Behavioral Health
• Long Term and Short Term Disability
• Managed Care
• Catastrophic Case Management
• Third Party Administrators
• Insurance Company
• Self-Insured Companies
• Government – Military

2. Provider Side positions

• Acute Rehab
• Acute Hospital Care
• Long Term Acute Care (LTAC)
• Skilled Nursing Facility
• Home Care
• Palliative and Hospice Care

SECTION II – How do I get a job in Case Management?

1. What steps should I take to get a job in Case Management?

2. Action STEPS Review

Step One: Identify the skills you have:

• Management/Administrative Skills
• Communication Skills
• Research Skills
• Human Relations Skills
• Problem Solving Skills

Step Two: Identify the skills employers are seeking
Step Three: Learn how to communicate the skills you have
Step Four: Continue to develop your skills.
Step Five: Be Flexible and Persistent

3. ACTION Verbs

4. Certified vs Certificate of Completion

5. SUMMARY

6. REFERENCES

• Recover Audit Contractor Program (RAC)
  
• Sample Job Descriptions

  a. Clinical Coordinator/works w/ RN CM
  b. Documentation Specialist
  c. Medical and Disability Case Mgmt
  d. Return to Work Case Manager
  e. Workers Compensation
  f. Acute Rehab
  g. Complex Case Management – Disease Management
  h. Insurance Company - CM
  i. Medicare - Evercare – Sr Care CM
  j. Pre-Cert/Concurrent Review
  k. Utilization Review Positions
  l. Discharge Planner RN
  m. Nurse Case Manager
  n. Nurse-Medical Case Manager-Workers' Compensation
  o. Disease Case Manager – Cardiac
  p. Case Manager-Utilization Review
  q. Case Manager-Grievance position

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