Job Profile: Nurse Case Manager

Nurse case managers are licensed registered nurses who coordinate long-term individual care services beyond the bedside. Also called case management nurses, nurse care managers are experts at pairing patients with resources they need within or outside their facilities. It’s their shared goal to find affordable, efficient healthcare services that suit every patient’s unique medical condition. Most nurse case managers will specialize in a select population, such as pediatric, elderly, transplant, head trauma, mentally ill, or cancer patients. Case management has played a vital role since the 1970s in eliminating gaps in quality patient care using both hospital and community-based resources. Nurse case managers develop individualized plans to ensure patients have the ability to meet established recovery goals.

Salary

Based on survey results from Salary.com, the median yearly salary for nurse case managers in the United States is currently $73,010. This can be equated to $35 per hour or $1,404 weekly. With bonuses, social security, pension, time off, healthcare, and disability included, it’s estimated that nurse case managers bring home a total compensation of $103,077 annually.

Beginning Salary

When just starting as a nurse case manager, you’ll likely land in the bottom 10th percentile of earnings with a yearly salary of $61,024. However, nurse case managers with years of patient care coordination experience eventually can make a base annual salary over $86,287. Those climbing to become case management directors could even make up to $139,854 annually.

Key Responsibilities

Nurse case managers have the primary responsibility of providing long-term assistance to patients and family members to advocate for their quality care. Case management nurses specialize in matching discharged patients with the aftercare, community, or mental health services they’ll need to achieve optimal well-being. On a typical day, nurse case managers can be found identifying patients’ insurance coverage, identifying patient risk factors, finding available resources, documenting case management plans, setting goals for treatment, educating families, scheduling doctor appointments, and coordinating surgeries. Nurse case managers collaborate with many types of healthcare providers offering the resources to help their patients’ reach desired outcomes within a specific timeframe.

Necessary Skills

Being a nurse case manager requires in-depth knowledge on how the clinical, legal, and financial aspects of the U.S. healthcare system work. Nurse case managers must be skilled communicators with the interpersonal skills to help individuals and their families. Problem-solving skills are essential to ensure patients access the right care regardless of budget constraints. Nurse case managers may need negotiation skills to persuade insurance companies and third-party community agencies. It’s essential that nurse case managers have organizational skills with a keen attention to detail for keeping meticulous progress reports. Nurse case managers must also have the technical skills to utilize electronic health records as well as facilitate the admission and discharge process.

Degree and Education Requirements

Before becoming a nurse case manager, you must acquire at least a four-year Bachelor of Science in Nursing (BSN) from a nursing school accredited by the CCNE or ACEN. If you’re already a registered nurse, many universities offer RN-to-BSN programs for accelerated degree completion. Taking courses related to case management, insurance reimbursement, disease management, health planning, motivational interviewing, and community health is advised. Many nurse case managers eventually attend graduate school. Earning a Master of Science in Nursing (MSN) with a Case Management track is increasingly being viewed as the standard. Some nurse case management administrators even obtain an MBA for leadership jobs coordinating patient care.

Pros and Cons of the Position

Like other nursing jobs, being a nurse case manager will provide a variety of rewards and challenges. On the plus side, nurse case managers earn a high average yearly salary with excellent benefits. Case management nurses have the freedom to specialize in a certain specialty, such as geriatrics, pediatrics, oncology, or psychiatric health. Nurse case managers typically work traditional eight-hour weeks from Monday through Friday. They may remain on call, but weekend and night shifts are less common than other RN jobs. Nurse case managers also develop longer lasting relationships with their patients, which is supremely rewarding. On the other hand, nurse case managers have an office desk job with less physical activity than other nursing roles. Competition for more advanced case management positions can be heated despite job growth. Nurse case managers typically invest significantly in their schooling and certification. Caseloads can also be large and lead to high amounts of stress.

Getting Started

While earning your BSN, begin filling your resume with professional nursing practice through practicum and internships. Building your clinical expertise at the bedside is best before moving into case management. Once you graduate, take the National Council Licensure Exam (NCLEX-RN) with your state board of nursing for licensure. You’ll then qualify for entry-level staff nursing positions. It’s recommended that you work at least two years as an RN before pursuing case manager jobs. Applying for certification can significantly aid in your promotion. Through the American Nurses Credentialing Center (ANCC), you can receive the RN-BC credential for Nursing Case Management. This requires active RN license, 2,000 clinical practice hours, and passing exam scores. Once you have 60 months experience as a nurse case manager, you can also receive Case Management Administrator Certification (CMAC) for leadership. Both designations require recertification every five years and CEU credits.

Future Outlook

Demand for case management services is only expected to rise. America’s large baby boomer population is reaching late adulthood, thus requiring more assistance with medical choices. Nurse case managers are needed to educate elderly patients living with chronic conditions, including Alzheimer’s, diabetes, arthritis, and hypertension. Thanks to the Affordable Care Act, health insurance has made affording long-term healthcare services easier. Case management nurses will be essential to ensure patients receive the best possible inpatient and outpatient care within insurance policy requirements. The BLS predicts that overall job growth for RNs will skyrocket by 16 percent through 2024. Nurse case managers should find favorable prospects in hospitals, rehabilitation facilities, nursing homes, home health services, hospices, insurance companies, and community clinics.

Overall, nurse case managers have an independent, yet multi-faceted role in coordinating healthcare resources for keeping patients healthy over time. Nurse case managers build relationships with patients getting to know their needs and preferences to develop an effective, personalized treatment plan. It’s their job to coordinate assistance within, between, and outside of healthcare organizations. If you become a nurse case manager, you’ll have the unique opportunity to easily navigate patients through the complex healthcare system.