How to Become a Case Management Nurse
Case management nurses are specialized registered nurses who manage the long-term care plans for patients with chronic or complicated medical conditions. These nurses work closely with patients and their loved ones to evaluate patients' needs and come up with a comprehensive healthcare plan that speaks to their preferences and goals.
Case management nurses generally have a concentration, a portion of the patient population on which they focus their greatest attention. For example, they will manage healthcare for patients coping with HIV/AIDS, elderly patients who are trying to manage several different medical problems, cancer patients, patients suffering from mental illnesses or deficiencies, or those awaiting or recovering from organ transplants.
Beyond managing patients' healthcare plans, a case management nurse also has the opportunity to work in a social work capacity, for example by helping patients and families to resolve financial issues. These nurses act as advocates to ensure that each patient receives the most cost-effective care possible. Advocacy includes medication management and scheduling medical testing and any necessary follow-up to ensure that each patient is heard and afforded the care he needs.
Acting as patient care liaisons, case management nurses coordinate the care that patients receive from each healthcare provider and manage plans for chemotherapy, radiation therapy or other continued therapies. They arrange for transfers among units within a hospital, or from a hospital to another care facility such as a nursing facility, rehabilitation center, long-term care facility, or homecare. The critical help they provide provides peace of mind and a sense of security to patients and their families.
Work environments for case management nurses encompass the private and public sectors and include facilities such as hospitals, rehabilitation centers, nursing homes and hospices. When working as an independent consultant, a case management nurse can choose both the work environment and the demographic of patients served. For a change of pace, they can seek a position with an insurance company. Insurance companies utilize the services of these professionals during worker’s compensation and disability coverage situations. Some highly motivated case management nurses enhance their careers by combining the responsibilities of both case management and traditional nursing.
At a minimum, case management nurses need to complete a two-year Associate in Nursing degree and become registered nurses by passing the National Council Licensure Examination (NCLEX-RN). Most employers prefer a nurse who has a four-year Bachelor of Science in Nursing degree, and some even specifically seek nurses who have achieved the level of Master’s Degree in Nursing.
A registered nurse who has already earned a Bachelor’s in Nursing degree who wants to advance his or her career can seek a Master’s in Nursing Case Management. To pursue a graduate degree, a prospective case management nurse must successfully complete a four-year undergraduate degree and receive a satisfactory score on the Graduate Records Examination (GRE). Post-graduate certification is available to registered nurses who have earned a master’s degree in another discipline.
After completing school requirements, case management nurses have the unique opportunity of gaining a large portion of their training on the job. Further educational training is obtained by attending continuing education courses and professional conferences and seminars.
Licensing and/or Certification
Certification options available for case management nurses include:
- The Commission for Case Management Certification Examination allows licensed, registered nurses to become Certified Case Managers.
- With a minimum of two years of hospital experience, registered nurses have the option of taking the American Case Management Certification Examination (ACM).
- After the two years of hospital experience, the addition of 2,000 hours of clinical case management experience and 30 hours of continuing education classes in case management nursing makes licensed registered nurses eligible to become board certified through the Case Management Nurse Certification Exam from the American Nurses Credentialing Center.
- Another option is to choose certification through the American Academy of Case Management (FAACM), which requires 60 hours of coursework, an exam, and additional work experience.
Necessary Skills and Qualities
A career as a case management nurse requires the ability to manage many important responsibilities simultaneously. Case management nurses must have in-depth knowledge of healthcare services and their application. They also need organizational skills and the ability to communicate effectively and clearly with patients and with various providers on behalf of these patients. Because they act as advocates for the most cost-effective healthcare plan for patients who require long-term care over the course of months, years, or even the rest of their lives, case management nurses must be able to illustrate the features of Medicare, Medicaid, and private insurance providers.
Opportunities for Advancement
Truly dedicated case management nurses can enter exciting and challenging managerial positions that allow them to direct teams of other nurses and manage the cases of several patients at once. Some employers require that job candidates be board certified in case management nursing to be considered for these advanced positions. Further education and certification improve job eligibility as well as earning potential and career advancement prospects.
According to the U.S. Bureau of Labor Statistics, in 2010 registered nurses earned between $44,190 and $95,130, with a median annual salary of $64,690. Due to their additional training and specialized skills, case management nurses expect to earn salaries that are equal to or greater than these numbers. Board certified nurses often earn higher pay, as do those who have taken on managerial responsibilities.
According to the U.S. Bureau of Labor and Statistics, faster-than-average growth is expected in the nursing field between 2010 and 2020, increasing by a projected 26%. Former inpatient services are now being transferred to outpatient facilities, which has increased the need for attentive care coordination by case management nurses. The demand for these professionals has also increased due to the obesity epidemic and the health problems that it causes, the higher average age of the U.S. population, and the advancements in technology that have lengthened life expectancy. Finally, the changing specialization within the U.S. healthcare system—wherein in the delivery of healthcare services is fragmented—will increase the need for management and coordination by case management nurses.