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As more complex medical treatment options emerged in the 1970’s, the concept of case management in healthcare came into existence as a means by which to eliminate gaps in the care provided, as well as needlessly duplicated treatment, all while controlling the cost of quality patient care.
Most case managers come from the fields of nursing and social work. Because of their clinical experience, nurses are uniquely qualified to bring an understanding of the clinical process of assessment, planning, implementation, and evaluation to the process of case management. Advanced practice nurses are particularly well suited for case management roles, as their graduate level clinical degrees better prepare them with the analytical and research-based competencies the job requires. In addition to clinical expertise, case management nurses need excellent communication and problem-solving skills and must know how the health care system works, including regulations, resource availability, and the financing of medical care.
As identified in the 2010 Role Delineation Study of Nursing Case Management National Survey published by the American Nurses Credentialing Center, some of the major duties of a case management nurse include:
- Documenting clients’ case management plans and on-going activities
- Identifying clients’ insurance coverage or other sources of payment for services
- Identifying and addressing client risk factors and/or obstacles to care
- Identifying client needs, current services, and available resources, then connecting the client to services and resources to meet established goals
- Communicating the care preferences of clients, serving as their advocate, and verifying that interventions meet the client’s needs and goals of treatment
- Screening clients and/or population for healthcare needs
- Developing a client-focused case management plan
- Educating the client/family/caregiver about the case management process and evaluating their understanding of the process
The survey also found that 60 percent of nursing case managers worked in hospitals, while 11 percent were employed by health plans or insurance companies who seek their services as a means by which to make the care process economically efficient. Others work in a range of settings that include rehabilitation and subacute facilities, community-based programs, and home care.
Nurse case managers may specialize in an area such as rehabilitation, pediatrics, or geriatrics. Typically, a nurse already specializing in a particular area of practice will move into a case management role in which their specialized knowledge is an asset.
Case Management Certification
Case Management Administrator Certification (CMAC) through the Center for Case Management is designed specifically for case management nurse administrators. This designation is often pursued by advanced practice nurses who have moved into case management who and are interested in a leadership position. Their graduate-level education also allows APRNs to meet eligibility requirements with fewer years of case management experience. Applicants must meet one of the following eligibility requirements:
- Hold a masters’ degree or higher and have 12 months of experience in case management administration
- Hold a bachelor’s degree or higher and have 36 months of experience in case management administration
- Hold a masters degree or higher and have 36 months of experience working as a case manager
- Hold a bachelor’s degree or higher and have 60 months of experience as a case manager
The CMAC exam covers the following:
- Identifying at-risk populations
- Assessing the components of clinical systems
- Developing strategies to manage at-risk populations
- Leadership
- Market assessment and strategic planning
- HR management
- Evaluating programs through outcomes management
Case Management Administrator Certification is available at a cost of $375. Recertification takes place every five years and requires credential holders to either retake the certification exam, or qualify for recertification through continuing education.
The American Nurses Credentialing Center (ANCC) offers a Nursing Case Management Certification that awards the credential RN-BC. The eligibility requirements to take the exam are:
- An active, current RN license in the U.S. or the equivalent in another country
- The equivalent of two years full-time experience as an RN
- At least 2,000 clinical practice hours in case management nursing during the three years immediately prior to applying
- Thirty continuing education hours of case management nursing during the three years immediately prior to applying
The computer-based exam is taken through Prometric Testing Centers and must be taken within 90 days of acceptance of application. Recertification takes place every five years and requires professional development.
Nurses in case management also have the option of becoming Certified Case Managers (CCM) through the Commission for Case Manager Certification (CCMC). In addition to having an active, current RN license and meeting the requirements of the CCMC Code of Professional Conduct, CCM candidates need to meet one of the following requirements:
- 12 months of full-time experience in case management under the supervision of a CCM
- 24 months of full-time case management experience without CCM supervision
- 12 months of full-time experience as a supervisor of individual providers of case management services
The three-hour, 180 question CCM exam is offered three times a year and covers:
- Concepts of case management
- Healthcare management and delivery
- Healthcare reimbursement
- Principles of practice
- Psychosocial aspects
- Rehabilitation
Renewal of the CCM credential takes place every five years and requires continuing education.
Case management nurses are also eligible to apply for a fellowship with The American Academy Of Case Management. Fellowship requires applicants to complete the academy’s continuing education program and pass an exam. Applicants who successfully complete the program receive the designation, Fellow in the American Academy of Case Management (FAACM).
Renewal of the designation takes place every four years and requires both continuing education and a minimum number of practice hours.
Other available case management certifications include:
- Certified Disability Management Specialist (CDMS) through the Certification of Disability Management Specialists Commission
- Accredited Case Manager (ACM) certification from the American Case Management Association (ACMA) (designed specifically for hospital case managers)
Case Management Education
Bachelor’s level education is seen as the minimal requirement for nurse case management positions, while graduate level preparation is increasingly being viewed as the standard. This has made advanced practice registered nurses uniquely well suited to these positions since the competencies developed at the graduate level better prepare nurses for the complexity of the nurse case management role.
Individuals interested in case management, but who do not already hold an advanced clinical degree as advanced practice registered nurses, do have options at the graduate level. The Master of Science in Nursing Case Management or an MSN with a case management track would be appropriate in these instances. Nurse case management administrators very often hold MBAs or MSN in Nursing Administration degrees as well. These degrees prepare nurses to coordinate client care, act as client advocates, and provide clinical management for groups of clients. Post-master’s certificates in case management are also available.
Although RNs can get into case management without additional education, more opportunities are available to nurses who gain additional competencies in the role and responsibilities of the nurse case manager. RNs can also obtain a non-degree post-baccalaureate certificate in case management. Some programs are specifically for nurses, while other programs are open to anyone with the background necessary to become a case manager, including social workers. Post-baccalaureate certificate programs provide basic academic preparation in areas such as case management concepts and process, coordination of services, financial considerations in case management, and disease management.
Case Management Associations
Associations for case managers include the National Association of Case Management and the Case Management Society of America. The Academy of Certified Case Managers publishes a bimonthly journal and offers CEU home study programs to maintain CCM and CDMS certifications.
The American Case Management Association is for case managers who work in hospitals and health systems. The National Association of Professional Geriatric Care Managers is made up of case managers working with families to care for aging relatives.
Case Management Nurse Salaries
ADVANCE for NPs and PAs 2011 salary survey revealed the following average salaries for case management nurses by region.