Become a Case Management Nurse in 3 Steps

Nurse Types / Case Management Nurse

When patients have more than one medical condition, it requires doctors across multiple specialties to collaborate on their care. Case management nurses are crucial to the process, ensuring teamwork flows smoothly to prevent negative patient outcomes. Upskilling your nursing abilities can help you become a case management nurse in 3 steps.

In this article, you’ll learn:

• What is a case management nurse?
• What do case management nurses do?
• Where do case management nurses work?
• How do you become a case management nurse in 3 steps?
• What are additional options for case management nurses?
• What are the salary and career outlooks for case management nurses?

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What is a case management nurse?

Case management nurses are Registered Nurses (RNs) who work with patients and providers to oversee specific care plans for their patients. When the Affordable Care Act became law in 2010, renewed focus was placed on preventative healthcare to cut costs and improve patient outcomes.

Your role as a case management nurse is to align the healthcare needs of each patient to their underlying health conditions. You’ll inspect each patient’s case before determining the best way to delivery quality care. Then, you serve as a patient advocate to ensure the care plan is followed.

What qualities does a case management nurse need?

You’ll need a keen attention to detail to be successful as a case management nurse. Patients with multiple health conditions require a delicate balance of care. Other qualities you’ll need as a case management nurse include:

• Conflict resolution abilities. As the person who manages the healthcare plan on behalf of an entire healthcare team, you’ll need excellent conflict resolution skills. If there is a disagreement among healthcare professionals, you’ll need to know how best to administer care.
• Negotiation skills. Part of your job as a case management nurse is to act as a patient advocate. You’ll need excellent negotiation skills to ensure your patients’ emotional and physical care needs are met.
• Problem-solving powers. When a patient has many healthcare-related needs, problems are sure to arise. You’ll need to think quick on your feet and solve problems in real-time.

What do case management nurses do?

As a case management nurse, you’ll handle a variety of tasks. For this reason, many nursing professionals enjoy case management because it keeps the job interesting. Some of the most common job duties for case management nurses include:

• Advocating for personalized treatment options that address your patient’s unique healthcare needs.
• Communicating information about your patients’ conditions with them and their families and ensuring they understand any instructions for continued care at home.
• Creating and managing care plans for patients with multiple health conditions.
• Educating and guiding patients as they navigate difficult medical decisions.
• Serving as a liaison between your patients and their health insurance providers to ensure cost-effective, quality care.
• Scheduling medical appointments for your patients and following up with them afterward.

What’s a typical day in the life of a case management nurse?

Your typical day as a case management nurse includes tasks like reviewing patient case loads and educating patients about their conditions and care options. Most of your day involves direct patient interaction, so you’ll want to brush up on your communication skills before starting a job as a case management nurse.

There’s a lot of paperwork involved with being a case management nurse. If you’re dealing with a patient with a Health Maintenance Organization (HMO) insurance plan, you can expect to complete plenty of reviews about the patient’s condition and progress to ensure the HMO continues to cover their healthcare costs.

What common conditions do case management nurses treat?

One of the best things about being a case management nurse is you’ll be exposed to a variety of patients with different combinations of healthcare needs. The work is never boring, but it does require you to stay updated on several health conditions. During any given shift, you may find yourself helping patients with:

• AIDS
• Alzheimer’s disease
• Cancer
• Heart disease
• Physical disabilities

Where do case management nurses work?

Case management nurses have their pick of where to work. Most medical facilities – clinics, hospitals, private physicians’ offices – hire case management nurses. 

It’s not uncommon for case management nurses to work for healthcare facilities that specialize in the management of long-term chronic conditions. These can include home healthcare companies, hospice care, and nursing homes.

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How do you become a case management nurse in 3 steps?

Case management nurses are Registered Nurses (RNs) that specialize in the management of patients with multiple healthcare conditions. It can take between 4 and 6 years to become a case management nurse. Your path depends on whether you study full or part-time and if you pursue an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN).

Step 1 – Become a Registered Nurse (RN)

Before you can start your career as a case management nurse, you must first become a licensed RN. There are two ways you can do this: earning an ADN or BSN degree. Some states require RNs to earn a BSN, while others have not yet regulated that level of education. You can check with the state board of nursing where you intend to practice to confirm their requirements for RNs.  

Earn a BSN degree

Earning a BSN degree has many benefits for RNs in any nursing specialty. It opens the door to more employment opportunities since more than 80% of healthcare organizations in the U.S. require RNs to hold an advanced degree. You’ll learn critical thinking and leadership skills beyond what is traditionally taught in an ADN nursing program. With a BSN, you also can earn specialty certification.

If you’re already an RN but you don’t have a BSN, you can work while continuing your education through an RN to BSN program. If you have a degree in a field other than nursing, you can earn an Accelerated Bachelor of Science in Nursing (ABSN) in less than 2 years.

Pass the NCLEX-RN exam

Passing the NCLEX-RN is the final step to becoming a licensed RN. The exam focuses on four areas:

• Health promotion and maintenance
• Physiological integrity
• Providing a safe and effective care environment
• Psychological integrity

Don’t panic if you fail the NCLEX-RN on your first attempt. You can take the NCLEX-RN exam more than once, but you must wait 45 days between attempts.

Step 2 – Accumulate experience

After becoming a licensed RN, you’ll want to work in a healthcare environment that helps you build valuable skills for your career in case management nursing. This means exposing yourself to a variety of healthcare settings where patients with multiple health conditions receive treatment. 

An emergency room or critical care unit are among the healthcare environments where you can learn the following helpful skills and experience.

Helpful skills and experience 

Some of the most helpful skills you can acquire on your journey to becoming a case management nurse include:

• Communication and collaboration. Each of your patients comes with a healthcare team that oversees their treatment. You’ll need to be able to communicate and collaborate with each member to ensure your patient’s emotional and physical needs are met.
• Cultural sensitivity. Patients come to healthcare facilities with diverse backgrounds. You’ll need to be sensitive to different cultures, ethnicities, gender identities, and races to be effective at your job.
• Time management. You may need to juggle numerous patients, each with their own multiple healthcare issues. Patient outcomes can suffer if you can’t keep up with the hectic pace.

Changing your specialty to career management nursing

If you’re already working as an RN under a different nursing specialty, it’s possible to change to case management nursing. You can prepare for the switch with targeted continuing education courses that help you build skills for your new nursing career.

RNs with emergency room experience make excellent case management nurses. They have experience with multiple health conditions and are used to the hectic pace of the ER.

Step 3 – Obtain certifications

Certifications for case management nurses aren’t required by all healthcare employers. If you have certification, it can give you an advantage over other candidates. There are four options for case management nurse certification:

• Commission for Case Manager Certification (CCMC)
• American Nurses Credentialing Center (ANCC)
• American Case Management Association (ACMA)
• American Academy of Ambulatory Care Nursing (AAACN)

What are additional options for case management nurses?

Case management nurses can open the door to career opportunities with an advanced degree. Options include pursuing a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP).

What are the salary and career outlooks for case management nurses?

Like all RNs, case management nurses are in high demand. According to the U.S. Bureau of Labor Statistics (BLS), employment of case management nurses is expected to rise by 6% between 2021 and 2031.

Salaries for case management nursing positions vary depending on location and employer. The median annual wage for all RNs is $82,750. The average pay for case management nurses can be anywhere between $59,485 and $75,873. You can earn more based on education and experience.

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Job satisfaction

Case management nurse satisfaction depends on the executive management team of the healthcare employer where you work. Managers can make or break a healthcare work culture. You can talk with other nurses at a facility before accepting a position there to get a feel for the work environment before you commit.

How can case management nurses advance their careers?

There are many advancement opportunities in the field of case management nursing. You can pursue additional education and certifications to become a nurse practitioner. If you enjoy the management side of things, you may want to explore opportunities in healthcare administration.