Filling vacancies always a challenge
RNs, CMs each have some advantages
Finding good case managers to fill vacancies is not always easy, asserts BK Kizziar, RN-BC, CCM, owner of BK & Associates, a Southlake, TX, case management consulting firm.
"The average age of practicing case managers is over 45, according to organizations that track those statistics. It's an aging population and there are not a lot of new people entering the profession," she says.
Nurses have the clinical background to be case managers, but they have to change the way they approach their role, Kizziar says. Nurses practice by the hour observing and evaluating patients, providing treatment and direct care. But when they become case managers, nurses must change their focus from the plan for the day to developing a plan for the stay, and looking ahead to the discharge process.
Hiring experienced case managers can have its pitfalls, adds Catherine M. Mullahy, RN, BSN, CCRN, CCM, president and founder of Mullahy and Associates, a Huntington, NY, case management consulting firm. Sometimes case managers from another organization find it hard to adjust to how their new department operates or bring in bad habits from the other organization. "It may be better to take someone who is not experienced in case management and teach them what they need to know to work in your department," she says.
Wendy De Vreugd, RN, BSN, PHN, FNP, CCDS, MBA, senior director of case management services for Kindred Healthcare Hospital Division, Western Region, Hospital Division with headquarters in Westminster, CA, suggests looking at new graduates from a master's in nursing program with a focus in case management. "Many are 'second career' students and come with a wide variety of tested, proven skills, and transferrable in the work field, as well as more advanced critical thinking skills, even as they need to be supported in entry-level nursing practice," she says.
Regardless of their background, good case managers have to have passion for the job, says Brenda Keeling, RN, CPHQ, CCM, president of Patient Response, Inc., a Durant, OK-based healthcare consulting firm. "Case management entails looking at everything. If the incentive and desire is not there, case managers are going to be just going through the motions. That's what happens if you hire someone with no experience and no real desire to take on the case management role," she says.
Keeling recommends hiring case managers who are willing to look at the whole picture — utilization review, quality, resource consumption, and discharge planning.
Whether they are working for an insurer, a hospital, a physician office, or another area, case managers need a strong clinical background and knowledge of basic medical and surgical clinical information as it relates to appropriate care plans or patient progress, Kizziar says. "Regardless of the setting in which they practice, case managers need to be able to determine the appropriateness of recommendations being made by providers. There are those who believe you don't have to have a clinical background to be a case manager and that case management can be taught. But having clinical knowledge is a huge advantage, and it would be difficult to be a competent and effective case manager without it," she says.
Kizziar recommends that new case managers have at least a year's worth of clinical experience. In some settings, particularly hospitals and managed care organizations, utilization review is a good place to start new case managers, she says.
"Utilization review is very specific in terms of work flow. It involves using algorithms to work through most of the determination and gives new case managers the opportunity to understand medical criteria and clinical needs as well as what both the provider and payer are looking for in terms of substantiating the need for services," she says.
Starting in utilization review allows case managers to smoothly move into the care coordination role, which has more of a focus on progression of care, she says.