Medical Case Management .. RN Medical Case Manager

  • R.N. Nurse Medical Case Management fees are generally $50 - $75 per hour + expenses.

  • The Nurse Case Manager functions as a patient's advocate in the complex environment of medical care in the 21st Century.
  • Facilitation of communication between all members of the medical team as well as with the patient client.

    A very important component of a R.N. Medical Case Manager's job is optimizing the patient client's benefit in relation to expense.

  • It is all but impossible for an individual to negotiate with treatment / care providers.  Case managers have a "stack of files" that gives negotiating power.

  • Nurse Case managers can negotiate prices.  negotiate with doctors, service providers, physical therapy, medications.
  • I always negotiate costs with medical providers in advance of the doctor issuing the order.

    • I discuss treatment options with the doctor & plan ahead to arrange therapy or diagnostics at favorable pricing / free transportation / extras.

    • I present my order as 100% profit to the medical provider .. cooperate by providing reasonable pricing & exceptional care for my client, or another provider will get the biz / profit.

    • I clearly explain that my clients deserve special priority treatment .. Case managers represent cash cows to providers & the smart ones are eager to please the cash provider.

    • The doctors appreciate my service & wish all their patients had case managers. My clients get the best care available & the docs know that.

    • Once the provider has the treatment order any leverage a case manager has is gone.

 

RN Case Manager's take on Medicare.  Medicare Part A.  Medicare Part B.  AARP Medicare Supplement.

 

Medicare should hire a team of RN Case Managers to control the escalating totally non-negotiated Medicare expenses.

"Oh, he's doing so well.  I think he'll be released today", said the floor nurse.

What that means to 'Bob & his family' is no more 'medication pump', no more nursing assistance, no more medical staff to answer questions, no ER a button away ..

 

Post hospitalization, when care is no longer centralized, is when the case manager's most difficult task begins ..

R.N. Nurse Case Management files are generally 'post acute'.

  • RN Case management files are generally for the first 6 - 12 months post injury / incident.

  • It is during this 6-12 month 'post event period' .. post event / injury .. that hard facts will be realized & hopefully dealt with in a meaningful manner.

  • Files can be pre-procedure.  Kidney transplant / heart procedures / and other such planned for major medical procedures.

  • & even then, it is more to prepare clients for the post procedure situation.

  • Facilitating communication between several very busy care providers.

  • 21st Century doctors are corporations.

  • Doctors see a huge # of patients per day .. it is the job of the R.N. Case Manager to ensure complete communication between all members of the medical team ... Doctor, Therapist, Nurses .. & client

    • Make sure the Doc has current (& all) therapy reports & current (& all) diagnostic tests results at appointments.

    • Make sure the Therapist has current Doctors orders & relevant reports.

Ask the hard questions.  I go in to each appointment with pre made forms & ask the same 'base set' of questions at each visit + any specific questions regarding my clients care plan. The patient client hearing me ask the questions is positive.

Dates .. future procedures .. diagnostics ordered / completed  .. possible additional diagnostics .. time frames.

  • If the client raises an issue with me, I address that issue to the medical provider in the presence of the client.

  • The patient has the same information as I.

    • If the client 'forgets' I emphasize the relevant issue at the next medical appointment.
      • Patient clients often have selective memories.
    • I review the clients diagnosis with him & provide visual aids when possible.
  • The case manager's client is the injured worker, the case manager should always ensure the the client is fully informed of all options.

Often a case managers primary role is to ask 'the hard questions' of medical providers.

  • + it is the 'squeaky wheel' that gets the attention ..

  • & MY GOAL is the medical team's appropriate focus & attention on MY client's medical plan.

  • Clarification of the medical plan.

    • Make sure every one involved, Client, Doc, Therapist ..  payer,  is clear as to the specifics of the medical plan.

    • Communication between all members of this interdisciplinary team must be open and complete in order for the medical providers to be objective with the injured worker and cooperative with the employer.

    • Make sure the doctor has the diagnostic / therapy reports, discuss the relevance.

    • Make sure the therapist knows vocational requirements and establishes an appropriate therapy plan.

The Case Manager's job is not to 'play pretty music'.

  • Realistic assessment of the injury & rehabilitation potential are vitally necessary for the injured worker's successful return to a fully functional life.
  • .. it is to first ensure the client understands the medical plan and rehabilitation plan ..

  • .. and then we facilitate the patient client's opportunity to optimize their specific rehabilitation.

  • Rehab is a very personal thing .. some relish in the opportunity optimum rehab provides, while others refuse to push through it.

A Case Manager's job is not to ignore the medical condition's vocational impact ..

  • Facilitating & encouraging a realistic vocational assessment ..  as determined by the interdisciplinary health-care team.

  • Facilitating  appropriate goal setting .,.  as determined by the interdisciplinary health-care team.

The RN Case Manager sees the 'post acute' patient client & family up close & personal.

  • The patient client family's real ordeal begins with post acute release from the hospital.

  • .. family burden .. loss of function .. pain .. uncertainty .. loss of income .. medication side effects..

  • Injured Workers and their families have real expectations and needs.

Often there is 'not a smiley face future' ..

& the sooner the client addresses the realistic future the better for all.  An Injured worker's role as a provider has possibly been removed .. human function lost . standard of living may decline .. homes lost .. not a pretty picture, but a real one.

If vocational retraining is the ultimate reality it should be addressed as early as possible in the medical plan.

Use any good news for motivation .. a part of the case management file is client motivation!

I often get calls from out of state Nurse Case Managers.  I always share all local information.

The US Army, US Marine Corp and the US Department of Veteran Affairs are in need of Nurse Case Managers. 

There is a huge need for Nurse Case Manages to assist injured Iraq & Afghanistan veterans.

To contact the VA regarding Medical Case Management careers: 1-800-949-0000

This can be an incredibly rewarding career.

medical care is an area in which globalization benefits the individual

Have yen to travel? TESOL / TEFL can be a good career choice.

Medical Tourism Book Store

Appropriate exercise, proper rest & planned nutrition ( intelligent lifestyle? ) are required for personal optimization.