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What does hospital case management nurse do? Anyone can provide an insight of how a daily routine like? Also, will you recommend anyone with no hospital experience but home care experience to start with this position? Thanks a lot.

September 28th, 2023

Hospital Case Management is pretty intense. As the others said, it takes a lot of team collaboration to plan a safe discharge for a patient. Add in family dynamics, patient rights making sure to use in network providers and timely discharges per protocol, it can be frustrating. I was a hospital Cm for several years then outpatient for a couple. Both have their pluses. I like the hospital because you see the patients in person. Really work with them as a team to help them achieve their discharge goals. Requires organizational skills, thick skin for those angry patients/family members. But I did love Case Management. I recommend job shadowing a case manager though. Just to get a feel for it.

September 26th, 2023

A hospital case management nurse plays a crucial role in coordinating patient care and ensuring efficient and effective healthcare delivery. Their daily routine typically involves:

1. **Assessment**: They assess patients' medical needs, treatment plans, and discharge requirements.

2. **Planning**: Developing and implementing individualized care plans, including post-discharge care and follow-up.

3. **Coordination**: Collaborating with healthcare providers, social workers, and insurance companies to streamline patient care.

4. **Advocacy**: Advocating for patients to receive appropriate resources and services, both within and outside the hospital.

5. **Documentation**: Maintaining detailed patient records and documenting care plans and progress.

6. **Education**: Providing patients and families with information about their conditions, treatment options, and resources.

7. **Discharge Planning**: Preparing patients for a safe transition home, arranging home healthcare services or rehabilitation as needed.

8. **Follow-up**: Ensuring patients receive necessary follow-up care and monitoring their progress after discharge.

As for whether someone with home care experience but no hospital experience can start in this position, it depends on the specific job requirements and the individual's qualifications. While prior hospital experience can be beneficial, skills in care coordination, communication, and patient advocacy gained in home care can also be valuable in a hospital case management role. Employers may provide training to bridge any knowledge gaps. Ultimately, it's important to review the job qualifications and discuss your specific situation with potential employers to determine the best fit.

September 7th, 2023

Outpt is just a lot of PDC (post DC) or preventative care… and a lot of pts refuse the help which makes it a bit frustrating since you can’t do your job. I worked for an ACO program which solely deals with Medicare and a lot of pts get wary and ask how you obtained their number and decline assistance. I prefer inpt :)

September 7th, 2023

I’ve been a case manager for about 1.5 years… I’ve done both inpt and outpt and they are very different. I personally prefer inpt because the day goes by quicker and it’s faster paced. Inpt days begin at 8am you get in gather all your pts/units for the day and begin to asses your pt’s charts on whether they are R Y G. Red pts can’t DC (acuity, surgery, etc), Y is pending something (placement, labs, etc), G is read for DC. You will then go to your 1-1.5 hour long meeting which includes various administrative staff members, MDs/NP/PA, PT, RN CM, SW, etc and you will provide info on your pts. After the meeting you’ll start working on your HLOC (higher level of care… usually a level 1 or 2 trauma center or any hospital that offers what the pt needs) and Y and G pts. Placing pts can sometimes takes weeks or even months or as little as a couple of days (depending on insurance and bed availability). Keep in mind that you will deal with a lot of family dynamics as well which makes things difficult. In addition, insurance companies will deny pt treatment etc and if you’re doing UR you will need to deal with all that. At the hospital I’m at we deal with insurance CMs but don’t deal with denials as we have a separate UR team. You’ll also do 1 day assessments which you will need to gather info on your pt’s living situation etc. you will work closely with the entire team… I never thought I’d need to collaborate with this many people but it literally takes a village to get a pt out! Outpt is much slower paced and deal with pts on a long term basis… think like 1-6 months! This can be frustrating but at least you’re working from home or from a smaller office.

August 30th, 2022

They facilitate any outside resources a patient may need , medical equipment and follow up appointments .. I would think it would depend on how well you can access patients needs in regards to and where / how do this .