What is a Case Management Nurse?

There are many specializations available to nurses today, including becoming a case management nurse. If you or a loved one has been assigned a nursing case manager you may have wondered what he or she would do for you. This branch of nursing is becoming more important as the cost of medical care increases and as the population ages and faces more health challenges. Case management nurses ensure that health dollars are spent appropriately and effectively.

What is Nursing Case Management?

According to Discover Nursing, these nurses are coordinators as well as service providers. They work with patients who need long-term care, making certain that medical issues, social aspects of life that affect health and financial reimbursements for healthcare work together to keep patients healthy and avoid hospital stays. Nurse managers generally specialize in a specific population such as those with a certain disease such as cancer or those of a certain age like pediatrics or geriatrics. The BLS projects a 19 percent growth in this field and lists median salaries as $48,000 to $66,000.

What Do They Do?

One of the primary functions of your case manager is to coordinate services of physicians, social workers and other medical and non-medical professionals involved in your case. They accumulate a wealth of knowledge about available resources. Nursing Explorer states they provide assistance “within, between and outside of facilities.” When you are first admitted to the hospital, a nurse manager may assess your condition and determine what care you will need while you are hospitalized and whether you will need continued care either in a facility or at home to meet your healthcare needs. Having a nurse manager working on your case helps ensure that unnecessary treatment is avoided and that needed care is given at optimum times to keep you healthy. That makes your healthcare more cost-effective and lessens the time you spend in a hospital. Nursing case managers must also be experts in understanding insurance reimbursement and what is and is not covered. If you are released from the hospital and need long-term care or care at home, your manager will make sure that resources like home healthcare, transportation services and other services work together to provide services that you need while avoiding unnecessary costs and duplication of services. He or she will function as a team coordinator.

Related Resource: Nephrology Nurse

What Training Do Case Management Nurses Have?

These are professionals with a minimum of an associate degree in nursing and who have passed the NCLEX-RN exam. Many employers are looking for managers who have bachelor’s degrees or who even hold a graduate degree in nursing. They must work as a registered nurse for a minimum of two years, after which they must accumulate 2,000 hours in case management clinical experience, then pass a comprehensive exam to become a Certified Case Manager. They are found in hospitals, rehabilitation centers and also may work as independent consultants. Because of this aspect of the job, the coordination between services, it is vital that people in nursing case management have people skills, and are good communicators.