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What is a Case Management Nurse?

case management nurseA case management nurse is a registered nurse who oversees patients’ long-term care plans. Such patients typically have medical conditions that are chronic or complicated in nature. Those employed in nursing jobs of this type work closely with patients and their families to evaluate the specific needs of the ill or injured person and create a comprehensive health care plan with a goal of matching those needs. Nurses specializing in case management may be employed by hospitals, rehabilitation centers, nursing homes, hospices or other facilities.

Duties

The duties of a nurse case manager vary significantly from one facility to the next, as well as from one patient to another. Some general duties of those employed in this field include coordinating medications, performing research, monitoring and tracking the condition and progress of various patients, overseeing medication and analyzing data. Nurse case managers also typically work in conjunction with the patient and his or her primary care practitioner to ensure that the appropriate care program is created.

In many instances, a nurse case managers must perform duties on behalf of insurance companies in order to advocate for patients while simultaneously reducing the cost of care. Case managers have less hands-on interaction with patients than floor nurses, as they primarily handle the administrative side of patient care. For this reason, they must possess strong organizational skills and be adept at maintaining files on each patient to whom they are assigned as part of their caseload.

Coordinating specific services for various patients is also an essential duty of a nurse case manager. The details of this task vary considerably, depending on the type of facility in which the patient resides. For instance, a person may have been admitted to a long-term care facility due to a chronic condition, and therefore require a case manager to oversee the services and treatment he or she receives on a regular basis. The nurse must monitor the delivery of services and verify that they conform to the treatment plan designed for the patient. If medical attention is required for the patient, the case manager is responsible for scheduling appointments with a physician and arranging the patient’s transportation to the hospital or doctor’s office. If the patient is not able to pay for medical help, the case manager typically speaks to social workers or similar individuals to obtain information about financial support services.

Skills

Those pursuing this nursing specialization as a career must be able to simultaneously manage multiple responsibilities. For example, they must possess in-depth knowledge of health care services and their various applications. In addition, they must have exemplary interpersonal skills so that they can competently and effectively communicate with patients and their loved ones. Because they are often called upon to advocate for cost-effective care plans for individuals suffering from long-term illnesses, they must have a thorough understanding of private insurance providers, Medicaid, Medicare and other programs.

Many times, it is the nursing case manager who must explain the different options available to the patient, as the latter may be confused about alternatives when speaking to a health insurance agent or Medicare or Medicaid representative. Understanding and being able to explain complex health care regulations are also duties that a nurse case manager must perform from time to time. Therefore, he or she must be familiar with HIPPA privacy rules and other laws when communicating with patients and their families.

Work Environment

Nurse case managers typically work in an office setting, but there are a variety of establishments by which they may be employed. For instance, they may work for an insurance company, as a home health nurse, or for a hospital or mental health facility. Research laboratories also frequently hire nurse case managers to oversee the progress and condition of those involved in clinical trials. Certain case managers choose to work as independent contractors and obtain multiple clients.

Training

Nurse case management training courses generally take approximately one year to complete. However, this year of training is in addition to the length of time it takes one to become a registered nurse in the state in which he or she plans to work. Certain universities and colleges offer programs to those with a bachelor’s degree in nursing science, while others require a master’s degree. Conferences, seminars and continuing education courses are other ways to acquire training in case management.

Case Management Certification

Various certification options are available for nurses who choose case management as a specialty. The following are some of the most common ways to obtain certification in this field:

  • Registered nurses who have at least two years of experience in a hospital or similar facility can schedule an examination with American Case Management–the organization that offers testing and subsequent certification.
  • An additional 30 hours of continuing education on the topic of case management and 2,000 additional hours of hands on experience in clinical case management qualifies a registered nurse to become board certified. However, this must follow two years of experience in acute care at a facility such as a general hospital. Certification of this type is typically awarded by the American Nurses Credentialing Center–ANCC.
  • Another alternative is to become certified through the American Academy of Case Management–FAACM. This organization typically requires that registered nurses complete 60 hours of coursework, obtain additional work experience and get a passing grade on an examination.

Additional Considerations

Nursing jobs involving case management offer additional options. For example, a registered nurse interested in becoming a case manager may choose to work with patients suffering from specific illnesses such as cancer, HIV/AIDS, mental illness or diseases that are terminal in nature.

According to the U.S. Bureau of Labor Statistics, nurses with a Master’s degree and several years of experience in the field of case management have the opportunity to earn as much as $62,000 per year. However, the exact salary depends on a variety of factors such as the location in which one plans to work and the type of facility at which he or she seeks employment. Anyone interested in working as a case management nurse should pursue the appropriate education to become qualified for this field.

Sources:

ANCC
eHow
BLS

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