It often take six months to a year for a new case manager to feel comfortable in the role, says Catherine M. Mullahy, RN, BSN, CCRN, CCM, president and founder of Mullahy and Associates in Huntington, NY.
That’s why case management departments must develop a formal training and educational program for new hires, mentoring by other staff in the department, and provide ongoing support, Mullahy says.
Training time varies depending on the experience and background of the new case manager, says Mindy Owen, RN, CRRN, CCM, principal owner of Phoenix Healthcare Associates in Coral Springs, FL, and senior consultant for the Center for Case Management.
“If someone has no case management experience, training is a minimum six-month process. If utilization management is part of the job, it could take as long as nine months or more to get new case managers ready to work on their own,” Owen says. If the new hire has case management experience, he or she may be ready to take on a caseload sooner, she says. “Training is an investment, both on the side of the case management and of the organization,” she adds.
Training for new case managers should include instruction on the role of case managers and not just the tasks they perform, adds Vivian Campagna, RN-BC, MSN, CCM, chief industry relations officer for the Commission for Case Manager Certification.
“They need to understand the big picture and how to manage an episode of care across the continuum,” she says.
Someone who is new to case management needs a formal orientation that lasts a minimum of eight weeks, Campagna says. As the formal orientation progresses, assess the person to determine if he or she can take on a caseload or if more support is needed, she says.
Campagna recommends pairing new hires with a preceptor before they work alone. “The preceptor gets a sense of how the new case manager functions, what they learned, and where they may need reinforcement,” she says.
No matter what kind of experience a new case manager has, says Peggy Rossi, BSN, MPA, CCM, ACMC-RN, CMAC, a minimum of four weeks of orientation is desirable. “They have to feel comfortable within the organization,” she says. “Ideally, orientation takes six to eight weeks, followed by time with a preceptor,” she says.
During orientation, Rossi recommends that the new case managers meet with case management leadership and staff members, and then spend time with the chief financial officer and heads of major departments.
“After orientation, the new case managers should spend half a day with the clerical staff to get a feel for the dynamics of the unit, and then shadow a case manager for a day. Then, the preceptor should assign them one of two cases and observe them to see if they need more training,” she says.
Before new case managers take on a caseload, rotate them through the surgery department, the ED, and ICU to make sure they get a good feel for the hospital, Rossi adds.
Nurses who have been on the floor must learn case management, says BK Kizziar, RN-BC, CCM, owner of BK & Associates. But rather than starting with true case management, assign them to perform utilization management tasks so they can learn what payers are looking for, what documentation is required, and the importance of coordinating with physicians, she says.
She recommends setting up a formal preceptor program with a comprehensive list of tasks new case managers must perform for their preceptor, and a clinical ladder that assesses ability, performance, and certification for the entire case management staff.
Encourage your staff to get involved with professional organizations and to attend conferences, Kizziar suggests.
Provide regularly scheduled educational sessions to keep the staff up to date on the latest payer regulations, community resources, and other information they need.
Case management departments must use a dedicated educator to ensure training is consistent for new hires. “When the training is done by staff, the new staff learn to do things the way their trainer does them and it’s not always the right way,” Rossi says.
In addition to training staff, the educator should keep the staff informed about policies and procedures and changing demands from payers, and keep the case management department’s orientation manual current so case managers will have an up-to-date reference source, she says.