What is a Nurse Case Manager?

A nurse case manager coordinates and manages a patient’s long-term care to ensure optimal healthcare outcomes.

These specialists coordinate care plans, track patient progress, schedule appointments, and identify improvement areas.

In many cases, outpatients regularly visit the hospital or healthcare clinic for checkups or other needs.

These patients are usually on a care plan related to some condition that requires routine care and monitoring.

As a result, the nurse case manager is often the patient’s primary point of contact inside and outside the hospital.

What Do Nurse Case Managers Do?

Nurse case managers perform numerous duties to ensure patients receive optimal care.

These nurses manage appointments, ensure patients receive proper treatments and refer them to healthcare facilities.

Nurse case managers are often the deciding factor for selecting and providing care for their patients.

Essentially, they will determine the necessary care and the next steps in a treatment plan.

Nurse case managers may coordinate with other professionals and take counsel from doctors.

However, they understand their patient’s needs through frequent communication and tracking their health status.

It means that the job is multifaceted and complex.

As nurse case managers work with patients and develop quality healthcare plans, they get to know their patients well.

These healthcare specialists frequently contact them both inside and outside the healthcare facility.

Sometimes, a nurse case manager chooses to specialize further in a particular healthcare field.

For instance, they may specialize in diseases like HIV or cancer or an age-related domain, such as pediatrics or geriatrics.

Some healthcare facilities recommend nurse case managers because they understand their patients’ conditions.

By specializing in case management nursing, these specialists acquire lots of training and experience in treating patients.

Nurse Case Manager Responsibilities:

  • Schedule and manage healthcare appointments
  • Monitor and track health statuses
  • Develop healthcare plans
  • Assist patients with specific healthcare needs
  • Help patients select appropriate providers
  • Identify areas of improvement
  • Advocate for better patient care
  • Perform routine patient follow-ups
  • Aid patient’s with insurance coverage
  • Offer resources, education, and guidance
  • Promote high-quality and cost-effective care
  • Help patients with hospital/facility discharge
  • Assist patients with healthcare system challenges
  • Coordinate long-term care with healthcare providers
  • Support patients through the entire healthcare process
  • Act as a liaison for the patient and healthcare providers

A nurse case manager typically coordinates patient care with physicians and healthcare specialists.

Where do Nurse Case Managers Work?

Nurse case managers work in various healthcare settings to ensure patients receive adequate support.

It includes hospitals, community health centers, outpatient clinics, rehabilitation facilities, and private practices.

They also operate in numerous departments like oncology units, palliative care, and other divisions.

Occupational Settings:

  • State and local hospitals
  • Community health centers
  • Outpatient clinics
  • Rehabilitation facilities
  • Long-term care facilities
  • Oncology units
  • Hospice care
  • Palliative care
  • Private practices
  • Insurance companies
  • Government agencies

A nurse case manager’s duties vary depending on their employer’s needs and specialty area.

For instance, nurse case managers in oncology departments concentrate on treating patients diagnosed with cancer.

Those in rehabilitation facilities may focus on patients with long-term physical rehab.

How to Become a Nurse Case Manager

There are numerous steps aspiring nurse case managers must take to join this profession.

It includes joining a nursing program, obtaining a degree, passing the NCLEX, gaining experience, and getting certified.

The following section provides a brief overview of the steps necessary to operate in this specialization.

1. Join a Nursing Program

The first step to becoming a nurse case manager is to complete a nursing program.

To enter the nursing program, students must complete multiple prerequisites and maintain a satisfactory GPA.

The prerequisite courses provide a foundation for the nursing program and ensure students understand the subject material.

It takes approximately 1 – 2 years to complete the prerequisites, depending on the student’s prior education and course credits.

After completing the required courses and maintaining a good GPA, students may apply for the nursing program.

2. Obtain an ADN or BSN degree

Qualifying nursing students can pursue either a two-year ADN or a four-year BSN degree.

The Associate Degree in Nursing takes roughly 16 – 24 months to complete, providing students with entry-level education.

This degree is ideal for those who want to enter healthcare quickly, earn an income, and gain experience.

Nevertheless, most employers and nursing specializations prefer those with a BSN.

The Bachelor of Science in Nursing takes 36 – 49 months to complete, providing students with a more thorough education.

Accordingly, it’s highly beneficial for those who want to specialize in various disciplines like case management nursing.

Many students pursue an ADN to quickly enter the field and take online nursing classes to obtain their BSN while working.

3. Pass the NCLEX-RN

After graduating from the ADN or BSN program, students must pass the NCLEX-RN exam.

The National Council of State Boards of Nursing administers the licensure examination.

This exam tests the competencies of graduates to ensure they have sufficient education to work effectively in entry-level jobs.

It also qualifies nursing graduates to obtain their licensure to operate as registered nurses.

4. Gain Experience

Once qualified to work, registered nurses need to start developing career experience in a clinical setting.

The exact work experience requirements to obtain a job in case management nursing will vary depending on the employer.

As a result, it’s beneficial to consult the facility manager to determine their provisions to operate in this domain.

It may include obtaining 2 – 5 years of experience in clinical care and completing numerous continuing education courses.

Registered nurses may also need certification to operate in non-entry-level case management nursing careers.

It’s highly advised that registered nurses accumulate two years or 2,000 hours of clinical experience in case management.

Some case management nursing careers offer entry-level jobs without certification for those with adequate experience.

Getting prior experience also helps registered nurses understand case management better to pass the certification exam.

The facility manager should know the registered nurse’s long-term education goals to get this experience while working.

5. Get Certified

After satisfying the experience provisions, eligible registered nurses may obtain their case management nurse certification.

It usually requires obtaining work experience, passing a nursing exam, and possibly taking extra credits or study courses.

Registered nurses may officially work as nurse case managers upon certification.

Nurse case managers must take approximately 30 continuing education credits to maintain their certification.

Registered nurses can obtain different case management certifications depending on their education and specialization.

The list below covers four distinct certifications available through the CCMC, ANCC, ACM, and AAACN.

Case Management Certificaitons:

The requirements to obtain each certification vary based on experience, education, and qualifications.

As a result, you must review each certificate to determine the required qualifications for the exam.

The previously mentioned academic and work requirements present what the certification programs may require.

Why are Nurse Case Managers Essential?

Nursing can be a demanding and rewarding career path for those who want to provide exceptional patient care.

Additionally, nursing is a continuously expanding profession in the healthcare industry.

Nurse case managers ensure patients receive the care they need to lead happy, healthy lives.

These specialists oversee the recovery process in ways other nursing professions cannot.

They obtain adequate knowledge of their medical histories by managing their patient’s cases.

They also oversee the long-term care of patients and coordinate with healthcare specialists to ensure adequate supervision.

As a result, nurse case managers positively influence the recovery process of long-term patients.

These specialists are vital for minimizing healthcare issues and managing important patient-related healthcare factors.