Nurse Case Manager: About the Job

For nurses looking to specialize in their careers, a role as a nurse case manager can be a challenging and rewarding choice. Serving as perhaps the biggest advocate for their patients, case management nurses use their knowledge and organizational skills to coordinate all aspects of patient care, from identifying cost-effective treatment options to communicating health status with the families.

Interested to learn more about the valuable role that RN case managers play? Keep reading to discover key information about job responsibilities, qualifications, and expected demand for this gratifying field.

What Is a Nurse Case Manager?

A nurse case manager is a registered nurse who coordinates overall care for patients in and out of medical facilities. These patients are typically recovering from severe injuries or illnesses—or are suffering from a chronic disease.

As a case management nurse, you act as a patient advocate to ensure that individual needs are met in the most effective and efficient way. You work to establish a plan that helps a patient follow through on recommended treatments and achieve the best possible results.

Types of Nursing Case Management

There are just as many types of case management nurses as there are specialties in nursing as a whole.

The position allows you to specialize in virtually any area, from short-term accident recovery to conditions requiring long-term care.

You can focus on treating patients who suffer from diseases such as cancer and diabetes or work with chronic conditions like mental illness or substance abuse.

In some positions, you can concentrate on a specific service, including rehabilitation, home health, or hospice care. Other specialties allow you to focus on one type of patient population, such as children in pediatrics or the elderly in geriatrics. A related specialty is utilization review, which is where nurses work with insurance companies to ensure that patients have the right insurance to cover procedures either short or long-term.

Nurse Case Manager Job Description

As a nurse case manager, your primary responsibility is to act as a patient advocate. Your duties will include helping patients and their families understand their health status and treatment options while ensuring that the patient receives the assistance necessary to follow through with their personal treatment plan.

While the details of a specific position can vary based on workplace and patient population, most nurse case managers perform a number of essential tasks:

• Communicate with patients and their families about a patient’s health condition
• Promote quality, cost-effective care, and patient outcomes
• Plan and coordinate care, resources, and services on a case-by-case basis with family members, medical professionals, and other health service providers
• Advocate for individualized options that meet a patient’s specific health needs

How to Become a Nurse Case Manager

If you’re interested in becoming a nurse case manager, you must first earn your license as a registered nurse. While qualifications differ by employer, most positions require at least one year of clinical nursing experience before you can begin case management.

In addition to this experience, most nurse case managers obtain additional education before taking on this role. These credentials might include programs, advanced nursing degrees, or case manager certification.

Education Requirements for a Case Management Nurse

While you can legally work as an RN with an associate’s degree in nursing (ADN), many employers require at least a bachelor’s degree in nursing (BSN) for advanced positions like nurse case manager. Moreover, some states are beginning to require RNs to earn bachelor’s degrees to maintain their licenses, and it looks like that trend will only continue.

After the successful completion of your degree program, you will then have to pass the National Council Licensure Examination (NCLEX) to earn your license as a registered nurse in your state.

In addition to a traditional BSN, it’s likely that you’ll need to supplement your degree with education in specific areas involved in nurse case management, such as ethical, financial, or policy issues. If you want to pursue an advanced degree, you can earn a Master of Science in Nursing (MSN) with a specialty in case management or a related field.

Case Manager Training for RNs

Case manager training for RNs typically begins with earning a BSN. If you got your RN license after earning an associate’s degree, completing an RN-to-BSN program will put you in a good position to advance to the role of nurse case manager.

Most RN-to-BSN programs are set up so you can keep working while you earn your degree. In addition to traditional classroom settings, online programs can provide the same education that case managers need while allowing you to arrange classes around your existing commitments. If you’re a working RN looking to get case manager training, you may qualify for employer tuition reimbursement programs to reduce the cost of your education.

Nurse Case Manager Certification

Certification is a formal process that validates your qualifications for a subject or specialty. While certification in nurse case management isn’t a requirement, earning this credential may increase your opportunities for employment and advancement.

You can earn your certification from professional organizations such as the Commission for Case Manager Certification (CCM) and the American Nurses Credentialing Center (ANCC). The requirements for education, training, and clinical experience vary based on the certification, so it’s important to select the option that best aligns with your career goals.

Who Employs Nurse Case Managers?

As a qualified case management nurse, you’ll be prepared to pursue a wide range of opportunities with a variety of employers. Case management nurses often work in traditional healthcare environments like hospitals and managed care facilities, however, you also can find roles in government-sponsored programs, home health agencies, private medical practices, and outpatient facilities.

Public and private insurance companies also employ nurse case managers and might offer opportunities for remote work via telephone or web-based patient communication. You also can pursue flexible and non-traditional positions as an independent consultant or traveling nurse.

Salary and Benefits

According to the U.S. Bureau of Labor Statistics (BLS), the annual median salary for a registered nurse is $81,220. When compared to the median wage for all occupations, nurse case managers have the potential to earn almost twice as much as the average U.S. worker.

Due to the specialized nature of the position, case management nurses might make even more than a general RN, along with added benefits such as overtime pay, health insurance, training programs, flexible schedules, paid time off, and a retirement savings plan.

Are Nurse Case Managers in Demand?

Nurse case managers remain in high demand as the healthcare system continues to work to find a balance between needs, resources, and costs. In the effort to increase cost-effectiveness and efficiency in treatment, RN case managers have become an invaluable asset to healthcare facilities. Their work in coordinating health services not only helps facilities lower costs, but also improve overall patient outcomes.

Job Growth and Career Outlook

The ongoing nursing shortage continues to create a demand for RNs of all kinds across the country.

Healthcare and an Aging Population

Today, there are more than 52 million Americans over the age of 65, and the U.S. Census Bureau expects that number to increase to 78 million by 2035. This population will likely bring with it an increase in age-related problems like arthritis and heart disease, leading to a higher demand for nurses to provide patient education and long-term care.

Other factors, like improved treatment, have allowed more chronically ill patients to live longer while still requiring ongoing medical attention. This will only continue to create a higher demand for the skills of RN case managers who can coordinate needs, resources, and treatment plans.