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Career Story: Nurse Case Manager

Nurse Case Manager

Job Title: Nurse Case Manager

Education: Associates degree in General Studies, Community College of Philadelphia •• Diploma in Nursing, Episcopal Hospital School of Nursing •• Bachelor of Science Nursing Degree, Immaculata University

Previous Experience: I worked as a staff nurse in cardiac unit after graduation for a year, then I went onto working as a gerontology nurse for two years, then worked as a Home Health Field Nurse for three years, then I was called by a commercial insurance company to do case management. I worked five years as a case manager working with the elderly, now I case manage members on Medicaid.

Job Tasks: My company provides health insurance coverage for people who are on Medicaid.

I check my work queue for the day, review the hospital census, if I have members (people who are insured with us) who are in my assigned hospital I review the hospital summary, place a call to the member, and once they are discharged I call them to review thier discharge instructions. I am responsible for making sure members in disease-specific case management get certain tests done, follow up with a specialist, make sure they have the required vaccinations.

I also assist the members with finding new doctors, making sure they are taking their medications, assisting with transportation. I teach them about their disease process, signs and symptoms to report to their doctor or nurse practitioner which is done over the phone and sending the member patient information to thier home.

Most of my time is spent talking with the members and doing care plans for each member that is enrolled in a disease-specific program, which are diabetes, congestive heart failure, asthma/chronic obstructive pulmonary disease (copd) and general case management. I provide case management for members who are more at-risk for hospitalization or serious, permanent or long-term effects from their disease. I interact regularly with the telephonic case managers, disease managers and social workers, coordinate care for members, and manage members with complex and multiple needs to ensure they receive appropriate healthcare.

I am responsible for the overall plan of patient care for a specific patient population. I coordinate appropriate resources to facilitate and ensure the member's progress through the continuum of care from pre-hospital admission to post-hospital care. I am responsible for assessment, planning, coordination, implementation, evaluation and completion of the care plan.

Best and Worst Parts of the Job: The best part of my job is reaching out to the members. The worst part of my job is when I am unable to reach a member because they either moved, phone number has changed or it was disconnected.

Job Tips: If you plan to have a career in nursing, do it only if you truly care about taking care of people. You will eat and breathe nursing school, its hard work but at the end its well worth it. Don't get into this field for the money, it will backfire on you.

Additional Thoughts: Nursing education does not stop once you pass the state boards, you have to stay abreast of what is going on. You can subscribe to nursing journals, take nursing continuing education (CE) courses which is now mandatory in the state of Pennsylvania.

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