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What is a Nurse Case Manager?

What is a Nurse Case Manager?

A nurse case manager is an occupation that combines the skills of a nurse and a social worker. They are expected to provide assessments for patients and tap resources to help with patient care. They are not only knowledgeable about healthcare but are also well-versed in understanding medical systems, insurance coverage, and hospital regulations. The majority of nurse case managers are employed by general and specialty hospitals, but other agencies like insurance companies have been known to employ them as well.

What Is a Nurse Case Manager?

A nurse case manager essentially arranges for the care and treatment of individual patients. They review available resources and choose the best options for the patient. They advocate on the patient’s behalf and will communicate with families, healthcare providers, and insurance companies to develop an effective plan for treatment. Nurse case managers typically start off as registered nurses (RNs) before entering the field. On the job, they are assigned to certain patients who require specialty care. For instance, a nurse case manager may be asked to assist a hospital patient who is moving into a nursing home.

What Does a Nurse Case Manager Do?

Nurse case managers make patient care recommendations to families after assessing the needs of the patient. They collect information from the patient, medical providers, and insurance companies to give safe and effective care recommendations. Their goal is not only to make decisions to improve the health of the patient but also to confirm recommendations are fiscally responsible. Caseloads for a nurse manager vary and will depend on where they are employed. If working for a hospital, they will perform duties that likely include:

  • In-patient evaluations
  • In-patient care plans
  • Discharge care recommendations
  • Insurance coverage reviews
  • Identify patient needs and offer resources

Since the nurse case manager makes medical recommendations, he or she needs to be a registered nurse. A registered nurse will have the capacity to review healthcare plans and provide clinical decisions on routine matters. For more serious medical issues, the case manager will get in touch with the patient’s physicians.

Besides hospitals, nurse case managers are employed by nursing homes, rehabilitative centers, hospices, home health agencies, and insurance providers. They perform the same duties in these settings as they do in a hospital, but the resources available may vary.

Why Are Nurse Case Managers Important?

Nurse case managers are given the responsibility of getting patients the best care possible. They are needed to educate patients and their families about healthcare options and whether insurance will cover the patient care needed. They review charts to assess patients and update care plans as needed. Patients and families may go to the nurse for emotional support and medical advice. This is why it’s important for the nurse case manager to have deep knowledge about symptoms, treatment options, medications, and procedures. Plans created by nurse case managers are always supposed to be centered on the patient and designed to serve his or her best interests. They must follow an ethical code to confirm their decisions are not made due to outside influences.

How to Become a Nurse Case Manager

A nurse case manager needs to have a compassionate, caring personality. In all situations, the professional should have the capacity to put the patient first. Nurse case managers must be detail-oriented since charting is a big part of their job descriptions. They must be a strong communicator since they will need to work with patients, families, doctors, and insurance companies to develop a care plan. Case managers are also resourceful since the job often requires them to look at a variety of options and choose the one most likely to offer the best possible outcome.

Education and Training Requirements

The educational background for a nurse case manager will start out the same way as an RN. Prospective nurses will enroll in a nursing degree program from an accredited college or university. Most hospitals and senior care facilities prefer nurse care managers have a Bachelor of Science in Nursing (BSN). Associate degree programs are also possible for those interested in becoming a registered nurse, but the individual may need additional courses to advance in the field. At the conclusion of the degree program, the prospective nurse will have to take and pass the NCLEX-RN examination. Nurses who pass the exam can then apply for licensing in their respective states. RNs who are interested in becoming nurse case managers should have valid and current licenses.

To become a nurse case manager, the registered nurse will want to earn a BSN if he or she has not already done so. To expedite the process, nurses can enroll in RN to BSN pathway programs and receive a BSN at an accelerated pace. These types of degrees are designed to allow the students to take many of the courses online while doing clinical hours at their current positions.

Registered nurses usually have a minimum of two years of experience before looking into nurse case manager positions. Master of Science in Nursing (MSN) programs can assist with preparation for the career change. Courses for an MSN degree will prepare them by teaching topics that include:

  • Advance assessment techniques
  • Nurse leadership training
  • Nursing and technology
  • Healthcare ethics

Not all facilities will require a master’s degree and will take experience into consideration. Nurses who already work in hospitals will be better equipped to handle the responsibilities required by nurse case managers. Colleges and professional nursing organizations hold training programs to prepare nurses for a career as case managers. The National Registered Nurse Case Manager Training Center has a selection of courses to provide both online and in-person learning options. Topics covered in the training are accredited by the AANC and teach about case transitions, care planning, ongoing assessments, improved patient outcomes, and patient barriers.

After two years of full-time experience, the registered nurse can look into certification options. Certification options include the following:

  • RN-BC: The RN-BC certification is sponsored through the American Nurses Credentialing Center. To qualify, you must have a minimum 2,000 hours of case management experience, a valid RN license, and 30 completed continuing education credits in case management.
  • ACM: For the ACM, nurses must pass a certification exam and have a minimum of one year of full-time case management experience.
  • CCM: To be eligible to receive the CCM (Certified Case Manager), applicants must pass the CCM examination, be an RN, and have been employed as a case manager for one to two years.

Nurse Case Manager Career Outlook

Nurse care managers must be comfortable working with patients from different backgrounds. They should not make blanket recommendations but should rather look at each individual case to find the best resources available. Legal issues can arise in the field and the nurse case manager should always act appropriately when making care recommendations. Patients and their families may be resistant to advice and prove difficult at times. Nurse care managers must remain calm and composed in high-stress situations. Most often, they will work a traditional Monday through Friday, nine to five schedule. Hospitals may request case managers work in shifts. Some case managers may have part-time work opportunities and may even be able to work from home. Some agencies allow case managers to telecommute part of the time and only come into the office a couple of days per week.

Nurse case managers will experience a surge in job openings over the next few years. Due to a numerous aging population and a call for specialized care options, all nursing jobs will increase by as much as 15 percent through 2026.

Salary and Employment

Salaries for nurse case managers are comparable to registered nurses. The Bureau of Labor Statistics reports that the median wage for registered nurses is $71,730 annually. The Economic Research Institute states a slightly higher annual wage of $79,864 for nurse managers. Case manager experience and geography will have a direct effect on how much the nurse earns annually. Top-paying states for registered nursing jobs include California, Oregon, Utah, Nevada, and Arizona. Certified nurse case managers will likely average a higher wage than non-certified individuals.

Nurse Case Manager Resources

Nurse Case Manager FAQs

Q: Can a nurse case manager be hired with an associate degree?
A: Not likely. The American Association of Critical-Care Nurses released a statement with the recommendation that all nurse case managers should have at least a Bachelor of Science in Nursing while holding the position.

Q: What types of patients do care managers work with?
A: Patients with special circumstances are usually assigned to a case manager. A nurse case manager may work with patients who need assistance getting transported from a new facility. Case managers could offer support and resources to patients who have been abused or assaulted. Additionally, hospice patients are typically assigned a case manager.

Q: Are there private practice opportunities for nurse case managers?
A: Yes. Nurse case managers can work independently and take on a consultant role. This allows for more flexible scheduling and higher salary payments. They may be asked to work for private insurance companies to assist subscribers.

Professional Organizations

Belonging to professional nursing organizations can help with career advancement. The organization may provide unique case management training or host networking events. Professional journals and online resources may be included with annual membership pricing. Nurse case managers can join these organizations:

Nursing Scholarship

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List of Nurse Case Manager Programs

Check out some of the best MSN programs to get you started on your path to becoming a nurse case manager.

What now?

A nurse case manager position allows you to work behind the scenes to optimize patient care. They earn competitive salaries and are exposed to less stressful situations than nurses in other roles. RN to BSN Programs can assist prospective case managers with finding the best degree program to meet their nursing career goals. Please contact the team at RN to BSN Programs with any questions about finding a job as a nurse case manager.

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