What Does A Case Management Nurse Do?

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Case management nurses are registered nurses who coordinate all aspects of the care of individual patients. They ensure proper utilization of services and resources as well. Case managers provide assistance within, between, and outside of facilities. Nurses working in case management facilitate outstanding patient care using fiscally responsible strategies. They are experts at obtaining resources. Case managers work with patients, families and other professionals. Case managers need to be savvy communicators, well organized, and creative. 

Case management nurses provide care in hospitals and in communities. Many work closely with social workers, obtaining services for people who need long term care or home care after hospitalization.

Case management is a collaborative process. They work closely with physicians, nurses, social workers and a wide range of medical and non medical professionals. Case managers work to meet complex patient needs. They make provisions for current and future needs of patients. Case management nurses promote quality care which encourages appropriate use of available resources. 

Case managers ensure that ethical and legal issues are addressed. They also ensure that patients receive medically appropriate services. They need to be experts regarding public and private insurance reimbursement policies regarding healthcare.  Case managers review charts and meet with other health care professionals to ensure that patients receive appropriate levels of care. They facilitate admission and discharge processes.   

Case managers work holistically, ensuring that care and discharge plans meet the physical, social, and emotional needs of patients.

Case management nurses must be registered nurses. Most have a Bachelor’s or advanced nursing degree however many case managers posses a Diploma or Associate’s degree in nursing. Case management certification is available and desirable, especially by insurance companies and hospitals.  Many case management nurses enter the field via on the job training and continuing education opportunities offered in the community or online.

Case managers use the nursing process to assess, plan, implement, and evaluate patient care and the use of resources. They monitor quality of care to ensure that infection control, risk management and all other aspects of services are appropriate.

Nurse case managers serve as patient, family, insurance, and facility advocates. Hospital case managers frequently work with patients coming from other facilities, such as nursing homes and assisted living facilities.  They work with hospice patients and accident victims. Case managers facilitate care of patients with mental health or substance abuse issues. Case management nurses provide assistance to victims of abuse and neglect.

Case managers work throughout the community. They provide diverse services. Case managers coordinate services for medically fragile children. They work in the insurance industry and in rehabilitation facilities. Case managers specialize in almost every field of nursing. There are community opportunities for nurse case managers to work with disease management, long term care, home health, hospice, and more.

Many case managers work eight hour Monday through Friday schedules. Others do nights and twelve hour shifts. Case management work provides opportunities in cosmopolitan and remote locales. Opportunities exist for nurses who enjoy field work. Some case managers are able to telecommute part of the time.

Case managers need to be able to interpret complex regulations and be skillful when working with computers. Case managers frequently need to spend more time sitting compared to other nurses. They need to be able to oversee patient care, considering multiple perspectives. Case managers must be able to oversee care based on the needs of the patient, with respect to family, community and reimbursement requirements.

Case managers work in diverse capacities. Some case managers provide short term assistance to patients while others may be actively involved with patients and family members for extended periods of time.

 

The annual salary range for Registered Nurses working the field of case management is from fifty three to seventy seven thousand dollars.

As budget cuts and managed care become more prominent, the roles of case managers will expand. Job opportunities will continue to increase.

Case management positions are often viewed as among the most desirable nursing positions within the nursing field. Competition for employment may be strong. Case management nurses are virtually always experienced nurses. Diverse opportunities exist for experienced nurses, however new graduates and nurses with limited experience are not usually hired into the field. 

  • The American Association of Managed Care Nurses (www.aamcn.org)
  • Commission for Case Manager Certification (www.ccmcertification.org)
  • Case Management Society of America (www.cmsa.org)

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