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.
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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.
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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.
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I discuss treatment options with the doctor & plan ahead to
arrange therapy or diagnostics at favorable pricing / free transportation /
extras.
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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.
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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.
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The doctors appreciate my service & wish all their patients had
case managers. My clients get the best care available & the docs know that.
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Once the provider has the treatment order any leverage a case
manager has is gone.
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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.
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Often transportation allowance or preferential treatment for my
client can be negotiated with medical providers .. negotiate before the order is issued.
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Once an order has been issued my leverage is gone.
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Therapy centers / diagnostic centers are almost always willing
to negotiate.
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The % profit for a medical provider is quite high for each additional patient
client (overhead is mostly fixed). Each additional client offers extreme
financial benefit for the provider.
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I can offer several new clients per month .. every month. The smart provider will
appreciate the opportunity to work with my clients.
"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 ..
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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'.
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RN Case management files are generally for
the first 6 - 12 months post injury / incident.
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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.
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Files can be pre-procedure. Kidney transplant
/ heart procedures / and other such planned for major medical procedures.
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& 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
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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.
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If the client raises an issue with me, I address
that issue to the medical provider in the presence of the client.
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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.
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+ it is the 'squeaky wheel'
that gets the attention ..
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& MY GOAL is the medical
team's appropriate focus & attention on MY client's medical plan.
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Clarification of the medical plan.
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Make sure every one involved, Client, Doc, Therapist ..
payer, is clear as to the specifics
of the medical plan.
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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.
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Make sure the doctor has the diagnostic /
therapy reports, discuss the relevance.
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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.
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..
it is to first ensure the client understands the medical plan and
rehabilitation plan ..
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.. and then we facilitate the
patient
client's opportunity to optimize their specific rehabilitation.
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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 ..
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Facilitating & encouraging a realistic vocational assessment .. as determined by the interdisciplinary health-care
team.
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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.
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The patient client family's real ordeal
begins with post acute release
from the hospital.
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.. family burden .. loss of function .. pain
.. uncertainty .. loss of income .. medication side effects..
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Injured Workers and their families have real expectations and
needs.
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An injury can potentially change all aspects of a person's
life: personal function, health, lifestyle and vocation.
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An Injured worker's role as a provider has possibly been removed .. human function lost
..
standard of living may decline .. homes lost .. families destroyed .. not a
pretty picture!
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Objective vocational assessment,
as
well as the medical plan assessment, of the work related injury or condition is critical.
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.
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Very often work related incidents are life altering.
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A lifetime of education / work / promotions
/ seniority .. all gone in a 'medical instant'.
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From respected work place producer to a '40 year old has been' in
community college classes with 19 year old freshmen.
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Happens every day .. could happen to
anyone of us!
If vocational retraining is the ultimate reality it should be addressed as
early as possible in the medical plan.
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Often injured workers stubbornly refuse to
accept this reality.
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Address this critical issue as often as
possible at client appointments with doctors & therapist.
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The opinion of the case manager does not
matter, it is the opinions of the medical care providers, docs & therapist, that
matter.
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Expose your client to medical reality from
the medical team as often as
possible. Good or Bad.
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.