A specialty in case management is a good option for registered nurses who want to advance their careers.
It is the goal of case management to facilitate timely discharges, prompt and efficient use of resources, collaboration with other medical staffers and coordination of patient care across the spectrum while improving performance leading to optimal patient outcomes.
Case management nurses monitor the quality and utilization of health care services and they intervene as is necessary.
The specific tasks involved in being a case manager can vary in different settings.
Social workers can be considered case managers particularly when they work in the area of mental health.
Their task is to assist their clients to access the medical and support systems which are available in their locality.
Nurse case managers who work for hospitals usually have one of three possible specialties: Utilization Review Manager, Quality Manager, or Discharge Planner.
A Utilization Review Manager works for a hospital or for an insurance company which runs a hospital.
This case manager reviews charts to be used by interdependent hospital systems.
The Utilization Review department is accountable to private insurance carriers for certifying and approving both acute and non-acute hospital stays.
The URM nurse in print scrub tops uses a standardized schematic of procedural transactions, diagnoses, indications of possible complications, and a standardized timeline in issuing her report.
A URM nurse works in close cooperation with URM physicians to monitor the quality of patient services.
For example, if review of a patient's utilization of services indicates that the patient can be moved from intensive care, the URM might request a change to ward services for that patient.
If the attending physician disagrees, the URM nurse may contact a URM physician liaison who can review the chart and discharge plan to either support or overrule the attending physician's decision.
To become a professional URM nurse requires at least three years of acute hospital practice.
Another case management option is in quality management.
In smaller hospitals in particular, quality management nurses in medical scrubs and uniforms, like URM nurses, are responsible for the overall quality of the care which is being delivered.
QM nurses also deal with risk management.
They work together with the hospital's risk management specialists, such as the QM physician and attorney's liaison, to put out legal fires which might be occasioned by patients' hospital stays.
The other case management option is that of a Discharge Planner, who coordinates all facets of a patient's admission and discharge.
Using standardized criteria, the DP nurse evaluates the high-risk patients.
The Discharge Planner nurse is like an investigative reporter, who must make available all of the financial and social resources which high-risk patients might need in order to have a safe discharge and post-hospital recovery.
DP nurses use their assessment skills and experience to review a patient's current situation, past medical history, and what support by family and friends exists outside of the hospital.
The DP nurse must also be familiar with Medicare and other insurance guidelines as well as the diagnostic guidelines.
DP nurses typically have a patient load of several dozen patients at a time.
It is the goal of case management to facilitate timely discharges, prompt and efficient use of resources, collaboration with other medical staffers and coordination of patient care across the spectrum while improving performance leading to optimal patient outcomes.
Case management nurses monitor the quality and utilization of health care services and they intervene as is necessary.
The specific tasks involved in being a case manager can vary in different settings.
Social workers can be considered case managers particularly when they work in the area of mental health.
Their task is to assist their clients to access the medical and support systems which are available in their locality.
Nurse case managers who work for hospitals usually have one of three possible specialties: Utilization Review Manager, Quality Manager, or Discharge Planner.
A Utilization Review Manager works for a hospital or for an insurance company which runs a hospital.
This case manager reviews charts to be used by interdependent hospital systems.
The Utilization Review department is accountable to private insurance carriers for certifying and approving both acute and non-acute hospital stays.
The URM nurse in print scrub tops uses a standardized schematic of procedural transactions, diagnoses, indications of possible complications, and a standardized timeline in issuing her report.
A URM nurse works in close cooperation with URM physicians to monitor the quality of patient services.
For example, if review of a patient's utilization of services indicates that the patient can be moved from intensive care, the URM might request a change to ward services for that patient.
If the attending physician disagrees, the URM nurse may contact a URM physician liaison who can review the chart and discharge plan to either support or overrule the attending physician's decision.
To become a professional URM nurse requires at least three years of acute hospital practice.
Another case management option is in quality management.
In smaller hospitals in particular, quality management nurses in medical scrubs and uniforms, like URM nurses, are responsible for the overall quality of the care which is being delivered.
QM nurses also deal with risk management.
They work together with the hospital's risk management specialists, such as the QM physician and attorney's liaison, to put out legal fires which might be occasioned by patients' hospital stays.
The other case management option is that of a Discharge Planner, who coordinates all facets of a patient's admission and discharge.
Using standardized criteria, the DP nurse evaluates the high-risk patients.
The Discharge Planner nurse is like an investigative reporter, who must make available all of the financial and social resources which high-risk patients might need in order to have a safe discharge and post-hospital recovery.
DP nurses use their assessment skills and experience to review a patient's current situation, past medical history, and what support by family and friends exists outside of the hospital.
The DP nurse must also be familiar with Medicare and other insurance guidelines as well as the diagnostic guidelines.
DP nurses typically have a patient load of several dozen patients at a time.
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