Case management nurses are an important part of the healthcare team. They are involved in monitoring every aspect of a patient’s care to ensure that patients receive effective and adequate care. Case management nurses communicate with physicians, health professionals and health-related service providers, such as insurance companies, to make sure that patients are receiving the best and most effective health services.
If you’re thinking about this type of nursing career, know that case management duties include the following tasks:
- Care Coordinator between disciplines (doctors, specialists, therapists, dieticians, etc.)
- Collection of information about the patient’s illness (vital signs, lab results, reports)
- Communication with doctors, insurance companies and referring providers
- Facilitates timely discharge, but makes sure patients’ get adequate care
- Makes sure patients do not get unnecessary care for their condition
Case management nurses are Registered Nurses (RNs), which have gone through additional specialized training. The additional training isn’t always required to be a case manager, but may be required in some higher level of care settings (ICU, Critical Care, Labor and Delivery, etc). Certification always increases the rate of pay for case managers. The annual salary for case managers is somewhere between $55,000 and $75,000. Some cases manager salaries can be as high as $95,000 and up for specialty work. There is excellent growth in this field, as hospital stays are becoming shorter. Case managers work to coordinate all care once a patient leaves the hospital. Case managers also have the opportunity for advancement to other management positions such as Director of Nursing or administrator.
There are accredited online universities that offer courses and certification in case management nursing; also you can substitute hours you have already worked as a case manager for certification. You can either obtain an Associate’s degree or a Bachelor’s degree. Again, the higher levels of education will increase your pay.
Here are some helpful tips to help you meet the requirements to work as a case management nurse:
- Learn about the job duties of a case management nurse. Case management nurses have a few different functions. First, they must assess a patient’s needs and coordinate care with the healthcare team and insurance company. Once the physician orders treatment, the case manager will come up with a Plan of Care (POC) and make sure that it is carried out. Case managers also check the “Quality of Care” and do “Utilization Review” to make sure people are receiving adequate, high quality care, but not un-necessary treatments. As soon as a patient is admitted to care, discharge planning begins. It is the responsibility of a case manager to coordinate services after discharge. The case management nurse will help sort out if the patient will need home care, medical supplies or referral to a rehabilitation facility. Case managers usually specialize in one area of care like pediatrics (children), labor and delivery or geriatrics (elderly).
- Complete a nursing education. The nursing education requirements for being a case management nurse are pretty much the same for when you become a Registered Nurse (RN). You can earn your Associate of Science degree (AS) in two years or you can earn your Bachelor of Science degree in four years (BSN). In any case, a bachelor’s degree is sometimes more preferred by employers, as this field of nursing is more advanced in nature. A bachelor’s degree can also offer you more career advancements and higher pay.
- Obtain your registered nursing license. After completing your degree you will need to take and pass the NCLEX-RN (National Council Licensure Examination-Registered Nurse) exam to become a Registered Nurse. The NCLEX-RN is a nursing licensure exam facilitated by the National Council of State Boards of Nursing. When you obtain your RN license, you are eligible to legally practice the nursing profession and train to be a case management nurse. Here are the requirements after you receive your RN license to train to become a certified case manager.
- Take a case management certificate program. This certificate program will walk you through the ins and outs of case management in the medical setting. Utilizing your nursing skills, the case management certificate program will prepare you for patient case assessment, care management and treatment monitoring. It usually lasts for a year, and its coursework normally includes hospital-based care management, cultural issues, disease and disability management, ethical and legal principles, managed care and psychosocial intervention.
- Obtain certification as a case management nurse. Upon completion of the case management certificate program, you can apply for certification in the Commission for Case Manager Certification. When you satisfy the requirements below, you will become a Certified Case Manager (CCM):
- Have a current valid RN license.
- Complete two years of full-time experience as a registered nurse.
- Work 2,000 hours of clinical practice as a case management nurse in the previous three years.
- Complete 30 hours continuing education in case management in the previous three years.
- Develop job related skills. To be a successful and effective case management nurse, you need to have the skills required of this medical job. Communication skills are very important in this position. You will be central to a patient’s care and will be communicating with doctors, patients, family members, other members of the healthcare team and insurance companies. You will have to be able to respond quickly to medical emergencies. You will have to know something about DRGs (Diagnosis Related Group Codes). These are the codes for the average length of treatment for each diagnosis. And because the job will also require you to do an evaluation, analysis and research, you must be a critical thinker, keen to details and observant.
There are a number of places to practice case management nursing. Since hospital stays are getting shorter, there is a large need for case managers in Home Health. Also, there are long-term care facilities, rehabilitation centers, drug treatment facilities, insurance companies and government agencies. If you prefer, you can also render consultation services.
Case management is a very rewarding field. While most nursing shifts are 8-12 hours any day of the week, case managers usually work 9 a.m. to 5 p.m. You have the opportunity to help others achieve the best quality of life possible while recovering from illness.