What Is a Case Manager in Nursing? CM Jobs Guide
The US healthcare system is in ever-growing need of case managers who can manage complex patient cases helping all involved parties save time and money. This increasing demand for case managers is due to many factors, including an aging US population, more chronically ill patients requiring complex treatments, and an overall increase in managed care.
Are you interested in becoming a case manager? Read on to discover if this nursing specialty is right for you. From certifications to salary to tips for new nurses, learn everything there is to know about case management in this ultimate guide.
What Does Case Management Mean in Medical Terms?
According to the Case Management Society of America (CMSA), the definition of case management is “a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost effective outcomes.”
Case managers contribute to their clients’ well-being and autonomy through advocacy, communication, education, identification of service resources, and service facilitation. Case managers also facilitate communication between clients and other healthcare staff and help clients identify appropriate providers and facilities.
What Does CM Stand For?
The abbreviation CM stands for case management or case manager. Similarly, the abbreviation CCM stands for certified case manager. Case managers are primarily registered nurses and may work in various settings, including hospitals, mental health clinics, crisis centers, legal advocacy organizations, welfare agencies, and schools.
What Is a Case Management Department in a Hospital?
Case management departments, also called patient and family resources departments, assist patients of all ages and their families during their hospital stays and also help them transition out of healthcare facilities. These departments are staffed by registered nurses, social workers, discharge facilitators, and administrative staff in collaboration with patients’ healthcare teams. Aside from assisting patients with case management, these departments coordinate care, provide behavioral services, and plan discharge or care transitions.
Here are some specific functions of case management departments:
- Collaborating with other members of the care team to develop care plans
- Optimizing clinical resources through ongoing communication with care teams and management staff
- Providing stabilization in emergent and urgent situations and crisis intervention
- Providing counseling regarding reaction to illness, disability, and end-of-life care
- Facilitating discharge based on patients’ needs
- Arranging for services such as home care, skilled nursing facilities, transportation, behavioral health, and acute rehab
- Linking patients and their families to additional resources
What Does a Case Manager Nurse Do?
A case manager RN collaborates with other healthcare team members to assess, plan, implement, and monitor patients’ care plans. Along with the rest of the care team, case managers use resources and services appropriately and facilitate patients’ safe transition or discharge from hospitals, among other duties.
What Is the Specific Role of a Case Manager?
Case managers visit patients soon after admission and are available to them throughout their hospital stay. The following are some of the responsibilities of a case management nurse throughout patients’ hospital stays and after:
- Coordinating care within the hospital: Case managers strive to increase patients’ health and comfort and inform the rest of the healthcare team of patients’ tests and treatments.
- Helping patients make decisions regarding their care: Case managers help patients understand their options based on healthcare goals, doctors’ indications, and insurance coverage. Additionally, case managers explain options regarding living wills and powers of attorney in relation to healthcare when necessary.
- Working with insurance providers: CMs help patients receive all the insurance coverage they are entitled to. They coordinate health insurance benefits and obtain approvals while patients are in the hospital and in preparation for patients’ discharge.
- Arranging care after hospital discharge: Based on doctors’ indications and insurance coverage, case managers make the best recommendations for patient care. If patients go home, CMs can arrange for medical equipment and nursing services in patients’ homes. If patients cannot go home, CMs will help patients transfer to rehab centers, skilled nursing facilities, or assisted living facilities.
“Case management is a lot of linking clients to needed services. You'll quickly get familiar with services such as medicaid, medicare, social security disability, etc. Housing, education, workforce training/employment/vocational rehabilitation, healthcare access, financial, legal, etc., are all notable areas where a case manager might be useful.” Reddit – u/LyricalMURDER
How to Become a Case Manager Nurse?
There are different pathways to becoming a case manager, but the overwhelming majority of case managers are registered nurses. Furthermore, most of these registered nurses have obtained bachelor’s degrees in nursing, and only a limited number hold associate’s degrees. In addition to their education and licensure, new case managers usually complete internships at hospitals, mental health clinics, care homes, or other facilities before full-time employment.
Case Manager Certification?
After licensure, internships, and other work experience, case managers can become certified. There are many benefits of certification, including the following:
- Certified nurses have a competitive edge over uncertified nurses and are more likely to obtain better jobs.
- Certified nurses can also aspire to higher compensation.
- Patients prefer receiving care from certified nurses.
- Nurses themselves feel more confident in the care they offer, feel more empowered, and collaborate more effectively with other healthcare team members.
Nurses interested in case management have many certification options to choose from. Read on to determine which option is the best for you.
Commission for Case Manager Certification (CCMC)
The Commission for Case Manager Certification (CCMC) offers the Certified Case Manager (CCM) examination. To be eligible for this exam, applicants must meet the following criteria:
- Education: Applicants must hold current, active, and unrestricted licenses or certifications in health or human services disciplines or baccalaureates or graduate degrees in health or human services fields that promote physical, psychosocial, or vocational wellbeing.
- Work experience: Applicants must have at least twelve months of full-time case management experience working under the supervision of a board-certified case manager (CCM®). Alternatively, applicants may have twenty-four months of unsupervised full-time case management employment experience or twelve months of full-time case management employment experience as supervisors of individuals who provide case management services.
- Character: Applicants must follow the CCMC Code of Professional Conduct.
American Case Management Association
The American Case Management Association also offers certification options in case management for both registered nurses and social workers.
- The Accredited Case Manager (ACM) Certification examination is available for registered nurses with valid and current nursing licenses and a minimum of 2,080 hours of supervised and paid case manager work experience.
- The Case Management Administrator Certification (CMAC) is available for RNs who have already obtained the ACM certification and have accrued 4,160 hours of work experience as case managers, case management administrators or leaders, or in roles consistent with the ACMA Standards of Practice & Scope of Services. Alternatively, eligible candidates may have one of the following qualifications:
- A master’s degree and one year of experience in case management administration
- A master’s degree and three years of experience as a case manager
- A bachelor’s degree and three years of experience in case management administration
- A bachelor’s degree and five years of experience as a case manager
How Long Does It Take to Become a Case Manager?
Since 88 percent of case managers are RNs, the minimum time required to become a case manager is two years for an associate’s degree. That said, most case manager RNs hold bachelor’s degrees in nursing, which require approximately four years to complete. Furthermore, becoming a certified case manager requires at least one year of work experience. Therefore, the minimum realistic time frame for becoming a certified case manager is five years. Evidently, this period can be significantly longer for case managers who pursue higher education and certification.
Case Manager Salary?
According to the US Bureau of Labor Statistics, RNs earn an average of $82,750 annually. However, the average RN salary can vary widely from state to state and across industries. The following are average salaries for RNs in different settings:
- Outpatient care centers: $93,070
- General medical and surgical hospitals: $85,020
- Specialty hospitals except for psychiatric and substance abuse hospitals: $84,800
- Psychiatric and substance abuse hospitals: $80,260
- Home health care services: $78,190
- Offices of physicians: $73,860
- Nursing care facilities (skilled nursing facilities): $72,260
Although less common than RNs, case managers can also be advanced practice registered nurses (APRNs). APRNs have pursued higher education and therefore earn significantly higher salaries. The average salary of APRNs is $118,040 per year. As is the case with RN salary, APRN average salary also varies across different states and industries. The following are average APRNs salaries in various settings.
- Home health care services: $133,170
- Psychiatric and substance abuse hospitals: $131,830
- Outpatient care centers: $129,190
- General medical and surgical hospitals: $122,960
- Offices of physicians: $114,870
- Offices of other health practitioners: $108,890
What Is Being a Case Manager Like?
Working as a case manager is a very rewarding career choice. Case managers have the opportunity to assist people with very complicated health conditions: Some patients are battling cancer, others are in rehab, and others are facing end-of-life health conditions. Case managers’ support and assistance in obtaining appropriate resources and services can make an incredible difference in patients’ quality of life.
That said, case management is not easy. Read on to understand the pros and cons of case management nursing.
Is Working as a Case Manager a Hard Job?
All nursing specialties have their unique challenges, which may be more or less hard to overcome depending on each nurse’s strengths and weaknesses. Here are some aspects of case management that nurses find the most challenging:
“Case management is brutal. You become the touchstone person for all of your cases and everyone - outside providers, in house agencies, outside agencies - EVERYONE expects you to be responsible for everything…case managers in my field always become the scapegoat for stuff out of their control or things not within their responsibilities.” Reddit – u/Such_Performance229
“Case management can definitely be exhausting, but it all depends on what support you have…Caseloads are consistently high, and turnover is always high so you’re constantly covering caseloads. With such a high caseload no matter how organized I try to be it is hard to keep up…My biggest struggle is entering case notes in a timely manner, make sure you have some system established because here I am almost 7 years later and I still struggle with finding the time!” Reddit – u/Sunnybunnypop
Why Choose Case Management Nursing?
Case management is not for everyone, but for nurses with strong organizational, communication, and interpersonal skills, this specialty can be very rewarding. Nurses don’t always get to see the fruits of their labors, but since case managers are involved with patients for a longer period, they are able to see how their advocacy, education, and support can help significantly improve patients’ lives.
“...you are gonna meet great people and the relationship that comes with time makes the work really rewarding, because you actually start to see progress with many clients over time.” Reddit – u/yeayeah_idontcare
“Then I get the families who are so appreciative, and see the kiddos blossom with having the support that they need which makes it worth it” Reddit – u/Sunnybunnypop
What Makes a Good Case Manager: Tips for New Nurses?
There is no better way to become a good case manager than to learn from those who have experienced the job firsthand. Here are some tips for new nurses that experienced case managers have shared on Reddit:
“It is an understatement that boundaries will save you. If you need to reschedule someone and prioritize, absolutely do it. But remember if you interact with a client who is difficult, they are a victim and not a villain. Learn some mindfulness if you haven't already. Stress management is a must. Self care is a must.”
“Key points: organization- find a method that works for you. Don’t be afraid to adjust it as needed. Excel is your friend! Keep up on your notes! Again, find a method that works for you and keep at it. Personally, I like to do my notes immediately after my visit or contact. That’s what works for me. In previous jobs, I would do them first thing in the morning for the day before. It worked perfectly at that time.”
Final Thoughts on Case Management
As with all nursing specialties, case management requires a specific type of nurse. Therefore, anyone considering case management should reflect on their personality traits, strengths, weaknesses, and preferences before making a career move in this direction.
Additionally, remember that no amount of information can beat the insights you can glean from hands-on experience. Therefore, before applying to a full-time nursing position or pursuing certification, consider testing the waters by picking up per diem nursing shifts in different areas to gather some experience and improve your resume.
