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To make a go of it as an independent practitioner, case managers must have a strong desire to do the job, know the rules and regulations involved in their profession, stand firm and resist the pressure to veer from doing things the right way, says Brenda Keeling, RN, CPHQ, CCM, president of Patient Response, Inc., a Durant, OK, healthcare consulting firm specializing in regulations and compliance.
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While the 12-hour work day has become the norm for nurses, there is new evidence that such longer shifts are not necessarily a good idea, especially when nurses work several consecutive days involving 12-hour shifts, or they are required to put in excessive amounts of overtime.
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Nancy Polites, LCSW, C-ASWCM, worked as a social worker for a home health agency, a hospital, and a hospice service before starting Elder Care Service, a case management service for seniors in 2007 with a colleague while she was living in California.
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Once upon a time, new case managers received their training and orientation as they rotated through the case management department.
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Theres 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.
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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.
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Faced with high readmission rates and patients who made multiple visits to the emergency department and were hospitalized frequently, a multidisciplinary team at Lehigh Valley Health Network began analyzing the cases of frequent utilizers one at a time, getting to the root cause of the readmissions, and developing a plan to keep them out of the hospital and emergency department.
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The Centers for Medicare & Medicaid Services (CMS) proposed rule for the 2014 Inpatient Prospective Payment System (IPPS) is subject to change, but hospital case managers still should familiarize themselves with the rule and determine the impact, says Ralph Wuebker, MD, MBA, chief medical officer for Executive Health Resources, a Newton Square, PA, physician advisor company.
