By Marie Stinebuck, MBA, MSN, RN, ACM

We all know how important first impressions are. As a new case manager hire, the first impression of your department occurs during their orientation and onboarding. This is a pivotal moment for several reasons, which will be discussed in this article. Not only will the quality of this initial program impact these new hires' first moments within the department, but it also begins to color their experience, impacting how valued and satisfied they will feel in their new role. 

The past several years have proven challenging to hire experienced case managers. Because of this, organizations are bringing on new CMs who are just entering the field. To be successful at your organization, these newer case managers depend on your onboarding and orientation program– on the tools and information you give them to do their job well. As someone who has analyzed and assisted case management programs in hospitals nationwide, I have gathered some key tips for the success of your orientation and onboarding programs. 

Before we dive into the details, I want to clarify the difference between orientation and onboarding. While the terms are often used interchangeably, the two have some differences. Onboarding is the ongoing process that begins during the hiring process of your new team member and continues until they are comfortable in their new position. On the other hand, orientation is one part of the onboarding process that begins on your new employee's first day and typically lasts between four to six weeks, depending on their level of experience. While both onboarding and orientation have elements that can be tailored to the unique needs of the new hire, onboarding is more customizable because it includes check-ins with a manager or mentor.  

Here are six ways you can build a strong onboarding and orientation program to place your new CMs and your department on the path to success. 

• Develop an orientation roadmap. 

Your new case managers need to be clear on what orientation entails. To help inform them, provide a roadmap that outlines your expectations for the first week and details the 4-6 week orientation period. This roadmap should specify what your new team member should expect each week, including hospital orientation, preceptor time on the units, and orientation to the department. It should cover logistics such as time-off requests, attendance expectations, and technology. One-on-one meetings with the manager and preceptor should be built into the weekly timeline to discuss progress and address any outstanding needs during orientation. The 4-6 week need for orientation should be based on the case management experience the new hire begins with and the current knowledge they bring to the role. Four weeks may suffice for experienced managers, but six weeks may be necessary for those new to the hospital setting. While you can include the same core competencies for everyone, adjust the timeline to meet the needs of each new team member. 

• Ensure access to department resources. 

This might seem obvious, but this is an easily overlooked part of the onboarding process. Each new hire needs access to all necessary department resources before working on the units, ideally from week one! This includes setting up their electronic medical record (EMR) access and aligning key components within the EMR to help them perform efficiently. Consider whether there are worklists or dashboards that would benefit them and align with their roles, units, or department goals. 

Another key resource your new CM needs is a standard patient list, which will inform their daily workflow. Determine which information is critical to include in the list, such as the estimated discharge date (EDD), geometric mean length of stay (GMLOS), and physician discharge orders. These components are crucial for driving conversations toward discharge dates and should be used daily by your new CM. 

• Remember to provide basic equipment, too. 

Ensure your new CM has the necessary electronics and office equipment to do their job! You'd be surprised how many new hires receive only some of their needs. I have heard plenty of case managers say they don't have standard office items, even months into their role.  

Though it should be a given, a standard office must-have includes a computer setup with a camera and speakers. Many department meetings and unit rounds still occur via Teams or Zoom, and your new hires especially need to be seen and heard during these calls. Consider if a laptop may be beneficial in place of a desktop computer. This allows the case manager to take the laptop to daily rounds on the units and the EMD for patient care discussions. 

• Use orientation checklists to your advantage. 

Orientation checklists help guide new CMs through their role's required skills, procedures, policies, protocols, and regulatory requirements. This competency tool should list categories to be reviewed and include a scoring range, which allows the preceptor to document the new hire's competency in each expected area of the role.  

Make sure that you keep this document updated. Regularly review and update your orientation checklists to ensure your new case managers get the most accurate, updated information possible. When changes in protocols or policies arise, update these checklists before you forget so they remain a reliable resource for onboarding. 

• Leverage the skills of your experienced case managers. 

Schedule time for your new case managers to shadow experienced team members to learn their tricks and tips. This hands-on learning experience allows new team members to see best practices in action and ask questions in real-time. Encourage experienced CMs to share their insights and provide feedback, creating a supportive learning environment. 

By pairing your new team members with seasoned ones, you can help foster a culture of communication and continuous improvement. And, if your new CMs feel supported by your existing team, they are more likely to feel satisfied and confident in their role in the future. Shadowing should occur on nursing units similar to those the new case manager will work on, as well as with CMs who excel in skills such as patient assessment.  

• Provide ongoing support. 

Even after orientation is officially over, your new CMs should still receive support. This can include ongoing 1:1 check-ins with supervisors or managers and completion of competency assessments to solidify role expectations and opportunities for continuous education. 

Consistent 1:1 sessions are especially important. When left to navigate new units on their own, it is easy for case managers to feel abandoned or overwhelmed. Regular support from a manager or mentor can help alleviate this anxiety and foster a supportive environment. 

Ultimately, I cannot stress enough the importance of a structured, strategic orientation and onboarding program. The best way to set your new case managers up for success is to provide all the necessary resources, stay consistent with ongoing support, and foster connections between them and your existing team. This will not only improve these employees' satisfaction and retention, but it will also enhance your department's overall efficiency and effectiveness.  

Invest in your case management department's orientation and onboarding processes, and you'll be investing in your organization's future. 

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Bio: Marie Stinebuck, MBA, MSN, RN, ACM, is the Chief Operations Officer of Phoenix Medical Management, Inc., the leading case management firm. Marie has practiced as a nurse for the past 26 years with 18 years in the field of case management. Marie has served in executive leadership roles with oversight of case management, utilization review, denials prevention, clinical documentation improvement, and medical record integrity. Marie has authored articles for RACmonitor and other case management resources and is a weekly contributor on Finally Friday. She has served as a board member for the Arizona Chapter of the American Case Management Association (ACMA) and holds an MBA, and an MSN in Leadership.