CM training includes education, preceptor

Complex role takes time to learn

At UPMC, an integrated healthcare system with headquarters in Pittsburgh, new case managers spend time on the floor observing a case manager, go through classroom training, then work with a preceptor before going out on their own.

“The role of a case manager is so complex that it takes a long time for a new case manager to become competent. As a large health system with 15 hospitals, we have developed multiple ways to give new case managers the information and the skills they need to do the job,” says Susan M. Almes, RN, BS, ACM, training specialist and a former case manager who is certified in InterQual criteria.

The new case managers typically spend one to four weeks in the hospital where they will work, observing and working with an experienced case manager, undergo eight days of intensive training in case management, then spend an additional six weeks with a preceptor back in the hospital.

The time period and content of the initial training for case managers varies from hospital to hospital but is designed to give new case managers a taste of what the job entails and open their eyes to what daily life is like for a case manager, Almes says.

“If they come straight to our training class, it is overwhelming. It’s better for them to first spend time on the floor to see firsthand how case managers interact with physicians, how they complete an assessment, how to make payer calls, and other day-to-day tasks,” she says.

The health system has a care management training department staffed by a project manager and four former case managers who undergo annual certification in InterQual. In addition to providing the monthly training sessions for new case managers, the department produces webinars and holds lunch-and-learn sessions at individual hospitals to keep case managers up to date on new rules and regulations and InterQual criteria. All case managers must pass annual competencies on discharge planning and the financial aspects of case management.

The classes for new case managers are held monthly for seven hours a day for eight days and are attended by an average of five or six new case managers. Topics include how and when to make payer calls, financial information, how to review a chart for medical necessity, all types of discharge planning, how to work with other departments such as social work, physical therapy, occupational therapy, the medical director, and when and how to request a secondary review of a case. The new case managers spend an entire day on InterQual criteria and must pass a competency test. They undergo extensive training on the health system’s case management software and post-acute referral software.

The training includes classroom instruction, including PowerPoint presentations and handouts, and scenarios of cases that allow the attendees to practice what they have learned each day. The entire last day of class is spent on scenarios, which include new admission documentation, readmission reviews, application of criteria, and creating a discharge plan. The slides and other hand-outs are included in a book that the new case managers take with them and can consult whenever they have questions.

The new case managers go back to their facility and work with a preceptor for as long as needed. A member of the training staff follows up about six weeks later and spends a day with the new case managers as they do their job. “We can answer questions and help them with areas they are struggling with. Sometimes we are called out earlier if the case manager director feels someone needs one-on-one training early on,” she says.

The case management director at the individual facilities decides when the new case managers are ready to go out on their own. “Case management is so rewarding, but it’s also so complex and demanding that it takes about six months for a new case manager to feel comfortable in the role and about a year before they feel like they really get it,” Almes says.