Tailor training to role of CM in your hospital

Give new hires time to learn their jobs

There’s no “one size fits all” for case management training, which means that hospitals need to create their own training and orientation process based on the specific responsibilities of the department, says Beverly Cunningham, RN, MS, vice president of resource management at Medical City Dallas Hospital. What is covered will vary from hospital to hospital, depending on the role of case management, she adds.

The first step is for case management directors to redefine the department’s policies and procedures that tell line by line what case managers should know and what they will be held accountable for, then develop job descriptions that fit with the policies and procedures. “The policies and procedures and job descriptions should be structured so that managers can use them during the annual evaluations for their staff,” says Peggy Rossi, BSN, MPA, CCM, a retired hospital case management director who now is a consultant for the Center for Case Management.

Start by developing a flow chart of the key processes in your department so you understand what they are, Cunningham says. Make a list of all the tasks case managers do in your hospital and make sure new case managers are trained on each and can demonstrate competency.

Create an orientation book so case managers know what is expected of them, have something they can study, and have something to go back to and review what they were taught, Cunningham says. The orientation book should be based on the functions of case managers at your facility and could include care coordination, discharge planning, utilization management, and resources management as well as compliance, Cunningham suggests. Use the case management structure at your particular hospital as a guide and add in hospital and department policies and procedures.

“It’s important to have an orientation plan and key people doing the orientation and mentoring who are giving the same message to every person,” Cunningham says.

Case management training takes at least four weeks of full-time training that includes listening to people from the various departments talk about how the case manager’s role fits into what their department does, Rossi says.

Include the chief operating officer, the chief nursing officer, and the chief financial officer to talk about their roles and how they intertwine with case management. “It’s extremely important for new staff to hear from the chief financial officer about the revenue cycle since case management can have such a big effect on reimbursement,” she says.

One-on-one training

One-on-one training is the best way, Cunningham says. “Most hospitals don’t have the luxury of having a person whose only job is orientation. The person doing the orientation might carry a caseload when there’s no one to train or might be a team lead,” she adds.

The case management educator should be someone with expertise who can communicate well and who has the ability to let case managers do things on their own while he or she stands back and watches. “You pay in the long run if you don’t have a good person doing the orientation and training,” Cunningham says.

Rossi suggest that case management clinical educators have extensive knowledge of the case management role. “Orientation for case managers must be more than the general information given to new nurses by the nursing administration. Case managers need to have specific information that nurses don’t need, such as Medicare and Medicaid rules and regulations, medical necessity criteria, and the revenue cycle,” she says. If the educator comes from outside the system, he or she should be employed in your case management department for at least six months, she adds.

When they are not training new case managers, the clinical educators should set up specific training for the staff on new rules and regulations. “Things are changing so fast in healthcare that six months from now, we may be doing things very differently,” Rossi says. The educators need to keep up with the various Medicare, Medicaid, and commercial insurance auditors, what they are looking at, and making sure that the processes and procedures within the department are current and that the staff have current knowledge, she adds.