How does a RN get case management/UR experience? I work with CM at each hospital but I’m told I need 2 years of experience before applying. CM to me is seeing what the patient/family needs in the hospital and to get to discharge.
CM does need to know what and how to set up discharge. CM also needs to know Medicare and insurance regulations as they pertain to hospital status, Inpatient, observation, PPR, status and what requirements are needed to change status of patients into highest paying potential. CM also needs to understand (pre Covid waiver) how these stays affect after care and services with home care and STR options. CM also needs to know regulations by CMS for IM, MOON and other required documents...Most facilities also have UR review such as a program called Inter Qual that CM need to have experience with in order to justify the stay of the patient.
Some jobs such as MDS in STR assist with the knowledge needed for the CM position. CM can also receive training through programs. Please do not confuse the role of CM with discharge nurse position as these two positions are very different, and have different expectations that need to be completed, and in my experience the CM can do the job of discharge nurse ....but not the other way around. .
I would think working as a CM for a hospital would be popular and highly sought after positions. Have you looked at other types of case management positions? State and local governments utilizes RN's for a variety of public health jobs. Infectious diseases, Medicaid, neonates, etc. I worked 25 years as a medical case manager for children in the foster care. It was mentally challenging but I loved it. These types of CM jobs are usually less popular, lower salary but better benefits and possibly a retirement plan, not just a 401k. Maybe something to think about.
Case management is more than discharge planning and ordering equipment to go home. As an RN case manager you have to evaluate the entire patient and anticipate the needs of the patient. There is education that needs to be done, patient needs that may need a referral for services and family dynamics. You gain these insights with experience and you learn how to look at the whole patient, coordinate diagnoses with medications, physiology of why and what the needs of the patient may be. You cannot get this from reading a book and passing boards, you need the clinical experience in order to develop these skills.
