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Ever hear the expression, "Always a bridesmaid, never a bride?" The certified case manager (CCM) accreditation from the Commission for Case Manager Certification (CCMC) in Rolling Meadows, IL, may currently be the most widely recognized case management credential in the industry, but many experienced case management professionals find themselves relegated to the sidelines because their job descriptions make them ineligible to sit for the exam.
If you find yourself in this position, take heart — experts say many have successfully appealed and earned their right to sit for the CCM.
"If a case manager is found ineligible to site for the exam, they will get an explanation from the CCMC," notes Carrie Engen Marion, RN, BSN, CCM, president of Advocare/Triage in Naperville, IL, who was the first chair of the CCMC and is currently serving again as CCMC chair until May 2001. "They will also receive the information on how to appeal that decision and the due process that is available to all rejected candidates."
Many rejections are based on a finding that the candidate’s job description does not clearly indicate that the case manager provides "care across the continuum," says Marion. "Case managers should take ownership of their job descriptions and make sure that what is in those job descriptions adequately describes what they do and if that description meets the needs of the CCM process."
The CCMC guidebook, Marion continues, clearly explains the eligibility requirements. It also clearly outlines the appeals process. If you receive notification that you are ineligible to sit for the CCM, here are several strategies others in your position have used to successfully appeal their eligibility status:
• Request a copy of the guidebook. If you don’t already have a CCMC guidebook, this is the time to request one and review it carefully, says Peter Moran, RN, BSN, MS, Cm, CCM, nurse case manager with Harvard Pilgrim Health Care in Wellesley, MA, and chapter president’s representative for the Case Management Society of America (CMSA) in Little Rock, AR.
• Review your job description. If your job description does not adequately describe your case management duties, write a letter on company letterhead, have it signed by your supervisor and notarized, suggests Marion. The letter should state your job duties with an eye to the requirements in the guidebook.
"We recognize," says Marion, "that there may be problems with job descriptions, and have given individuals the ability to provide additional documentation. You as the candidate also must evaluate whether what you are doing is case management or another role with the title of case management. You have to then either change your case management program or job change your job title to more adequately describe what you are doing."
If a standard job description doesn’t fit the bill, write a "day in my life" scenario, suggests Anne Llewellyn, RN-C, BPSHA, CCM, CRRN, CEAC, owner and independent case manager with Professional Resources in Management Education in Miramar, FL. "Think outside the box and write down examples of your daily work that support the things you say you do. Get your supervisor to sign it. We all do so much each day. Many of us think it’s just part of my job, so it’s not special.’ Everything counts — as long as you can validate it."
The CCMC eligibility standards have been a catalyst for change in many case management programs, continues Marion. "A good example of this is occupational health nursing practice. Years ago, many occupational health nurses with traditional occupational health programs were found ineligible to sit for the CCM. Many programs changed to adopt a more case management focus within their organizations and the roles of the occupational health nurses expanded," she says.
• Network with others in your practice setting. "I advise professionals to contact other case managers in similar work settings, who have been allowed to sit for the exam," says Moran, "Ask for a copy of their job description."
Many home health and hospital-based case managers, Moran adds, have found that the simple acts of a follow-up telephone call and a preadmission assessment meet the requirement to provide "care across the continuum."
If a hospital-based case manager speaks to a home health agency to arrange care after discharge, checks up on the patient after they get settled at home, and talks to the physician who is following the patient during rehabilitation — they are working across the continuum, argues Llewellyn. "If they call themselves case managers, and they aren’t doing those things — they should be!"
Sometimes, human resource departments within health care organizations fail to keep pace with current practice, notes Jeanne Boling, MSN, CRRN, CDMS, CCM, executive director of the CMSA. The best way to avoid eligibility roadblocks, she says, is for "case managers [to] assure their job descriptions are accurate prior to applying for certification."
Many hospital case managers do follow patients once they leave the hospital, agrees Marion. "The problem comes," she cautions, "when there is no follow-through and a large part of the case management process is missing."
Boling adds, "Case managers do not contribute to effective outcomes if they do not follow up on their work into the community to assess transition problems."
• Lobby your employer to change your job. The one thing case managers certainly should not do, stresses Boling, is inaccurately portray their job functions. She continues, "Case managers should be honest and describe exactly what they do. If what they do doesn’t meet the accepted standards of case management, they should lobby to modify their jobs to meet the standards."
And, not everyone has to be a case manager. "I fail to understand the drive to have different jobs, such as discharge planning and utilization management, called case management," confides Marion. "I think what the CCMC’s position is that episodic management in one isolated care setting is not serving the needs of the patient very well or providing for any consistent care. I think all case managers should, as much as possible, do care across the continuum. I think case management has a specific body of knowledge, including the process of case management, and anything that does not include that process should be called something else."