What Is Nursing Case Management?

The healthcare system is complex. Patients with conditions that require intensive treatment, multiple procedures or visits to specialists (like cancer, diabetes or Alzheimer’s disease) can benefit greatly when someone knowledgeable guides them through the care process.

Nursing case management fills that role. Although nurses generally work with a specific patient for a short period, like the length of an office visit or hospital stay, case management nurses develop longer-term relationships with patients. They “help patients and doctors coordinate, implement, and oversee care plans over the course of an illness,” says the site EveryNurse. “In fact, it is not unheard of for a case management nurse to be with patients from the start of their injuries or illnesses to the end.”

What Are the Primary Duties of Case Management Nurses?

Nursing case management aims to increase collaboration among the care team, and as a result, reduce hospitalizations for high-risk individuals and improve patient experiences and outcomes. To achieve this, case management nurses — sometimes called care coordinators — have a range of responsibilities.

Case management nurses primarily “focus on care coordination, financial management and resource utilization to yield cost-effective outcomes,” says the Nursing Case Management Review and Resource Manual. In addition, they strive for “patient-centric, safe” care “in the least restrictive setting.”

Case management nurses also:

  • Assess the health and psychosocial needs of patients
  • Identify available resources and services to satisfy patient needs
  • Develop a case management plan, in collaboration with all healthcare providers, customized to the patient’s specific illness and care goals
  • Communicate regularly with patients and healthcare team
  • Oversee patient discharges and assist with safe transitions of care
  • Schedule patient’s medical appointments
  • Monitor patient’s adherence to treatment plans
  • Encourage the patient to ask questions and actively participate in their care
  • Educate the patient about treatment options, insurance coverage and benefits
  • Help patients use the healthcare system
  • Reevaluate care plans and adjust accordingly to ensure progress toward goals

Where Do Case Management Nurses Work?

Case management nurses work in many settings, such as:

  • Hospitals
  • Long-term care facilities
  • Insurance companies
  • Hospice
  • Palliative care
  • Oncology clinics
  • Home healthcare agencies
  • Community health centers
  • Psychiatric facilities
  • Private practices

What Skills Do Case Management Nurses Need?

Case management nurses frequently function as the central point of contact between patients and the care team, so they must excel at clear and consistent communication. In addition, they must have the clinical competencies to consult with numerous healthcare providers, then relay pertinent information to patients. Case management nurses should also have experience performing detailed health assessments and a keen awareness of the socioeconomic and psychosocial factors that affect patients’ care access and compliance.

Other top skills beneficial in this role include:

  • Leadership
  • Organization and planning
  • Teamwork and collaboration
  • Decision-making and problem-solving
  • Empathy
  • Resilience

How Do You Become a Case Management Nurse?

A career in case management requires proficiencies in both the clinical and administrative aspects of healthcare. Because of the breadth of knowledge and skills necessary, nurses interested in becoming case managers benefit from advanced education.

The online Registered Nurse (RN) to Master of Science in Nursing (MSN) program at Lamar University prepares nurses for leadership roles while strengthening their nursing practice. The comprehensive curriculum combines Bachelor of Science in Nursing (BSN) and MSN coursework, resulting in significant time and cost-savings for nurses who already have an associate degree in nursing (ADN) or diploma.

Nurses may also consider certification to improve their job prospects. Nursing case management certifications are available from the American Nurses Credentialing Center (ANCC) and the Commission for Case Manager Certification (CCMC).

Nursing case management involves a unique blend of clinical and administrative responsibilities. Nurses interested in this rewarding career typically benefit from advanced education and certification. As insurers and providers seek to reduce healthcare costs and rehospitalizations, demand for case managers will likely continue to grow.

Learn more about Lamar University’s online RN to MSN program.

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