If you enjoy researching and patient advocating then opting to become a nurse case manager could be perfect for you. If this sounds like an interesting case, management nursing could be the career for you!

How to Become a Nurse Case Manager Guide
How to Become a Nurse Case Manager Guide

Quick Summary

The Nurse Case Manager follows a patient’s case (hence the name – Nurse Case Manager) until they are discharged out of a hospital by a physician.

While the patient is still in the hospital Nurse Case Managers help, locate outside resources that a patient may need once discharged out of the hospital. This ensures patients have a smooth transition back into their homes or are transferred to another inpatient or outpatient health care facility.

Degree needed to practice: Bachelors of Science in Nursing (BSN)

License Needed: Registered Nursing License

Certification: Nursing Case Management Certification offered by The American Nurses Credentialing Center (ANCC).

How much do Nurse Case Managers make?  The Median annual salary is $67,490*

 

What does a Nurse Case Manager do?

The benefits of becoming a nurse case manager are seeing patients become discharged and leave knowing they have everything they need to make a full recovery. The majority of Nurse Case Managers enjoy great work hours and most work Monday through Friday occasionally weekend calls and work daytime shifts.

The nurse case manager’s job begins when the patient is admitted to the hospital. Every patient that is admitted to the hospital can operate with a nurse case manager. The service provided by nurse case managers is not just reserved for one type of client or one type of client need.

When patients are close to being discharged, the nurse case manager will sit down and have a face-to-face conversation with the patient and the patient’s families to find out what their needs are and find out what the patient wants.

Universal Nurse Case Manager Duties

  • Work closely with patients their families and their physicians to ensure they receive the best care possible
  • Provide face-to-face consultations with patients or patient’s representatives while they are in the hospital locate and make referrals for the patient for hospital aftercare discharge
  • Provide patient status to the patients’ insurance company as requested
  • Develop a plan of care for a post-hospitalization visit
  • Arrange follow-up appointment for the patient and or any tests that may be needed
  • Help to prepare the patient’s transfer to other health care facilities

Whom does the nurse case manager work with?

Nurse case managers work in collaboration with social workers, physicians, and the patient’s insurance agency to help ensure the patient’s needs are identified and can be successfully met. Sometimes this career can be stressful because the wants of the patient may not be what the physician feels the patient may need.

Where can a nurse case manager work?

Although nurse case managers’ primary role is to help prepare patients for discharge within a hospital setting they can work in many settings and healthcare specialties. Nurse case managers can even specialize in specific patient populations such as geriatrics. Nurse case managers can be found in other settings such as:

  • Large and Small Hospitals
  • Acute or Emergency Care Units
  • Rehabilitation Centers
  • Long and short-term Assisted Living Facilities
  • Nursing Homes

What resources does the Nurse Case Manager help locate for the patient?

Once the nurse case manager finds out what is needed, they will get them set up with resources such as home health, physical therapy, assisted living facilities, and send out referrals. If the patient needs medical equipment such as a walker, bedside commode, or even oxygen tanks, the nurse case manager will make sure this medical equipment is available for the patient upon their discharge from the hospital.

What is the purpose of the nurse case manager?

The purpose of Nurse Case Managers is to help connect patients to community resources if needed. In addition to keeping patient re-admissions down. Many times the nurse case manager begins a discharge plan for the patient right when the patient is admitted to the hospital.

Unfortunately, patients that have been discharged without receiving proper discharge planning may not have the necessary resources to make a full recovery.

These patients are readmitted to the initial hospital facility. According to “Reducing hospital readmission rates is a national priority. Approximately 20% of Medicare beneficiaries are readmitted within 30 days of discharge, and these readmissions have been estimated to cost the American public >$15 billion per year.”

The nurse case manager also works closely with the patient’s insurance company to help make sure that the patient’s hospital stay is meeting the medical guidelines in addition to ensuring the insurance company will provide financial reimbursement. Part of the nurse case manager’s job is to figure out the patient’s eligibility for financial assistance with the patient’s insurance company.

Nurse case manager’s job can be frustrating at times

At times, this can be very complicated because sometimes the patient’s insurance company does not want to pay and cover certain services and treatments. Sometimes a physician may find it necessary for the patient to stay extra days be on the days the patient’s insurance company approved them.

This is where the nurse case manager will get in contact with the patient’s insurance company to try to get additional approval. To ensure the patient can get an extension to get the required hospital care they need.

Patients insurance companies had regulations and patients protected by state laws that require their length of stay and their hospital treatment to be monitored this is to ensure that their level of hospital care is appropriate.

Why are nurse case managers so valuable to the health care industry?

Medicare can penalize hospitals that have high readmission rates. According to Kaiser Health between the years of 2011 and 2014, there were 2,592 hospitals penalized losing a combined 420 million dollars in readmission fines.

Many hospitals view this as unfair however this goes back to just how valuable nurse case managers are to the health care and nursing field. They help provide patients with the resources they need and help keep costs down for hospitals across the nation.

Why become a nurse case manager?

Many times the nurse case manager will work with the patient for long periods, and often they make a difference in the patient’s life long after the patient has been discharged from the hospital.

Deciding to pursue this career, you can help protect the patient’s welfare and ensure the patient transitions to the next level of care with the resources they need in conjunction with keeping the rising costs of hospital readmission’s down. One of the biggest benefits of nurse case managers deciding to pursue this career is the bond they create and form with the patients.

Characteristics and skills needed to be a successful Nurse Case Manger

Strong understanding of patients –  Patient needs with a genuine interest to help.

Research skills – Locate needed and prescribed resources for patients within the community.

Communication and interpersonal skills – This career involves working directly with patients, their families, and other medical team members daily.

Have compassion – Be willing and open to put the patient’s needs first.

Listening skills – The ability to pay close attention to what the patients have to say as well as the physician and be on top of your game with knowing both party’s needs and wants.

Patience with the ability not to get frustrated that easily. Working with both physician and patient can become frustrating. Sometimes the patient may not tell you everything that is going on with them until they are discharged. Once they become released, and they request resources, it may be too late.

Sometimes the physician may decide on what will be best for the patient however the patient will not want what the surgeon is recommending. So being a median with plenty of patience will help you thrive within this career.

 

What education is needed to become a Nurse Case Manager?

To become a nurse case manager, you must first complete a four-year bachelor’s program, a three-year hospital diploma program, or a two-year associate’s degree program and pass the NCLEX-RN licensing examination to become a Registered Nurse (RN).

Licensing is required by all 50 states to practice as a Registered Nurse.

To ensure the nursing school, you select the highest educational standards to make sure you enroll in a nursing program that is accredited by the CCN or ACEN. Both are the leading accreditation bodies for nurses.

In nursing school, you will take classes in nursing theory, human sciences, and human growth and development. You will also participate in clinical experience programs at hospitals and other healthcare facilities in the two years of your BSN degree program.

A bachelor’s degree is recommended if you would like to compete in future competitive nursing employment positions. Also, a bachelor’s degree program is highly recommended for those who would like to gain administrative or supervisory positions and higher salaries.

 

What Certifications are available for Nurse Case Managers?

There are several benefits of earning certification. Some advantages include showing the public and your employer that you have met the standards of practice and providing professional recognition along with credibility.

Certification is voluntary however many employers prefer to hire Nurse Case Managers that have received their certification within their specialty. The Nursing Case Management Certification is offered by The American Nurses Credentialing Center (ANCC). The qualifications to become eligible for this national certification is:

  • Registered Nursing License that is active and in good standing.
  • Two years of registered nursing working experience.
  • 2,000 hours working within the nursing case management area within the last three years.
  • Must have obtained 30 hours of continuing education within the field of nurse case management, this also must be completed within the last three years.

 

Career Outlook

Nursing specialties will be in high demand as The Bureau of Labor and Statistics (BLS) 2020 Guide predicts employment for all nurses is expected to grow much faster than average. The BLS is predicting nursing employment will increase by 32% through the years 2020 to 2030.

The demand for nurse case managers is expected to grow within the coming years due to hospitals having a mandated discharge planning process they must follow. In addition, The Affordable Care Act aimed at reducing the number of hospital re-admissions of patients annually. This in return creates a significant demand for nursing students desiring to pursue this career.

Read also – How to Become a Registered Nurse (RN) Guide

Check out our other Nursing School Guides.

 

References

https://www.census.gov/