A Guide to Becoming a Nurse Case Manager

Written by Sasha Blakeley

Nurse Case Management

Within the nursing field, there are many different specialized roles. For nurses that want to develop more long-term relationships with patients, nurse case management is an excellent choice. RN case managers provide specific and much-needed support for patients whose needs might otherwise be overlooked. Patients whose recovery will take months or years, or those who need to focus more on management than recovery, need someone looking out for them and knowing what treatments were tried in the past and what might work in the future. Becoming a nurse case manager is a good option for highly organized nurses with great attention to detail and value relationships they can form with patients.

This guide will address the questions many nurses pursing the field have such as: what a nurse case manager does, traits and characteristics of a nurse case manager, job and career outlook, as well as the steps current and prospective nurses can take to enter the field.

What Is a Nurse Case Manager?

Essentially, a nurse case manager is a registered nurse who creates and helps administer long-term care plans to certain patients. Geriatric and hospice patients, those with chronic illnesses and injuries, and people recovering from a traumatic injury are all typical patients for nurse case managers to take on.

Role of a Nurse Case Manager

The role of a nurse case manager will vary depending on their place of work and specialization. A typical nurse case manager will have a portfolio of clients whose care they manage. Each case will start with an initial meeting with the client and sometimes with the client's doctor to determine the necessary treatment and develop a plan. Case managers will help their patients access the care they need over the subsequent weeks, months, or years. One of the major tasks that nurse case managers need to handle is coordinating which treatment options will be covered by a patient's health insurance. Case managers should be prepared to give patients and their families bad news if necessary treatment is not covered. That can be one of the harder aspects of working as a nurse case manager.

In many ways, nurse case managers are a step removed from the daily tasks usually associated with nursing. Most registered nurses spend most of their working hours in direct contact with patients. They provide immediate care for patients, including administering medication, doing medical tests, caring for wounds, and explaining treatment options to patients and their families. Regular registered nurses work with doctors and other healthcare professionals in hospitals, long-term care facilities, clinics, and more.

Nurse case managers do spend time with their patients but do not usually administer treatment directly. Instead, they develop a care plan that other healthcare professionals, including registered nurses, carry out. Most work that nurse case managers do is essentially behind the scenes: they write plans, consult patients' health insurance for options, coordinate a treatment timeline, and more. They communicate this information to patients, their families, and other healthcare professionals involved in their patients' care. Although much of the administrative work that case managers do may be invisible to clients, patients must get the care they need.

Traits and Characteristics of a NCM

Several personal and professional skills help nurse case managers thrive in their workplace. There are benefits and drawbacks to working as a nurse case manager, and this specialization is not for everyone. Case management nurse jobs often require a higher level of education than other nursing opportunities, and job openings may be more limited than for regular RNs. Nurses who thrive in the high-speed work environment of a hospital may feel stymied by a more limited caseload. For some RNs, however, becoming a nurse case manager is the ideal career step. There are ample opportunities to provide meaningful care for patients and delve deeper into long-term care strategies that many nurses may not use as frequently.

Many people will need to cultivate these skills over time, while some may come more naturally than others. The following list is not exhaustive, but it may give those considering this career a sense of how well they think they would do. Important skills and traits include:

How to Become a Nurse Case Manager

Those interested in learning how to become a case manager should realize that this is a specialization for registered nurses, not an entry-level position. It can take some time to get established as a nurse case manager. While it is a great goal for those going into nursing, anyone who wants to be a nurse case manager should also be prepared to spend time working as a regular RN first.

Pass the NCLEX Exam

The first step to becoming a nurse case manager is to get a nursing degree. While it is possible to become a registered nurse with an associate degree in nursing (ADN), the case management specialization is only open to RNs with a bachelor of science in nursing (BSN) degree. It usually takes approximately four years to earn a BSN from an accredited college or university. A BSN provides students with a combination of academic coursework and practical experience working in a healthcare environment. After earning a BSN, prospective nurses will need to pass the national nursing exam called the NCLEX-RN. Nursing programs will typically prepare their students and guide them through studying for and hopefully acing the NCLEX exam. NCLEX practice tests are also available online to help prospective nurses prepare for the real thing.

Once individuals have passed the NCLEX test and become fully licensed as registered nurses, they can seek employment at any hospital or clinic. There is no specific amount of time that individuals have to work as regular RNs to be considered for case manager positions, but most hospitals and clinics prefer to hire RNs with at least five years of experience. During those years, RNs who want to become nurse case managers should expand their network and build up their leadership and management skills to be prepared for the responsibilities of case management. They should also ensure they have strong administrative skills and an excellent understanding of patient care trajectories.

Obtain Case Manager RN Certification

Some RNs elect to pursue dedicated nurse case management training through specialized courses. Once they feel prepared, prospective case managers can apply for a specific certification required to practice as a case manager. There are several different certification options, but the Certified Case Manager (CCM) Certification is the best known. Once they have the required certification, nurse case managers are free to pursue employment and get started in their new career specializations.

Certified Case Manager Certification

CCM Certification is one of the most common and well-respected forms of case manager certification. It is not actually legal to practice as a nurse case manager without it. There are several prerequisites aspiring nurse case managers must fulfill before they can apply for CCM Certification. The first prerequisite is a bachelor's degree in nursing. The second is RN licensure, which is obtained by passing the NCLEX-RN. Finally, applicants must have at least one year of experience working in case management. This experience usually involves working as an apprentice or assistant to a certified nurse case manager. Such positions may be available through hospitals for interested RNs.

Accredited Case Manager Certification

While many nurse case managers choose to pursue CCM Certification, there are two other options. Some choose to get Accredited Case Management (ACM) certification. The prerequisites are similar: applicants must have a valid RN license, experience with a certified case manager for at least a year, and also use their supervisor as a reference. The third form of case management certification is to go through the American Nursing Credentialing Centre (ANCC). This route also requires an active RN license, two years of nursing experience, 30 hours of training in a case management program, and 2,000 hours of case management work. These certification options also involve passing a specific exam as part of the application process.

Case Management Nurse Jobs

Since nurses are not the only ones who can be case managers; they may find several case management professions. Many of these jobs either overlap with nurse case management or are considered subsets of nurse case management. Other non-medical specializations provide the same kind of long-term support for clients that nurse case managers do. It is helpful for nurse case managers to understand what all these other professions are because it is not uncommon for a patient or client to work with several of these professionals at the same time. Nurse case managers may need to liaise effectively with their patients' other case managers to ensure all of their care needs, medical and otherwise, match up and complement each other. Some case management professions besides nursing include:

Although these case management jobs have different descriptions, they are not dramatically different in their required duties. There is a lot of overlap between these professions, and several of them can be done by trained nurses.

Variables to Nurse Case Management

Four major elements of nurse case management impact the work an individual is likely to do on a day-to-day basis. These are the four axes of case management, and any nurse case manager will fall somewhere along each axis. These different aspects of case management make up the work an individual is likely to be engaged in. Not all RN case managers will get to choose exactly where they fall on each of these axes, but it is helpful to keep this framework in mind when applying for jobs or exploring potential career options.

Patient Needs

One thing that varies from one nurse case management job to another is the set of diseases or conditions patients have. Some case managers may work primarily with patients with chronic or progressive illnesses like ALS or cancer. Some might specialize in working with patients with dementia or Alzheimer's, while others work mostly with patients with mental health needs. There are also case managers whose patients are recovering from car crashes, traumatic brain injuries, or other serious accidents. There is no guarantee that case managers will only have patients who fall into one or two of these categories, but many nurse case managers do notice trends in their own patient caseload.

Duration of Care

All nurse case managers work with patients who need relatively long-term care, but what exactly constitutes ''long-term'' can vary. Acute injury rehabilitation, surgery recovery, and some mental health issues may only need treatment plans that span a few weeks or months. Other patients, especially those with chronic or degenerative illnesses, may work with the same nurse case manager for years or even decades. Many nurse case managers tend to work primarily with one or the other group of patients, though this is not a hard and fast rule.

Populations Worked With

There are specific populations who may be more likely to need the help of a nurse case manager. Elderly patients are a large population group that many nurse case managers work with. Others may work primarily with children, particularly those with cancer and other serious illnesses or those who have been badly injured. It may be helpful for some nurse case managers to lean into working with one population over others to develop consistency in their care style and approach. For instance, the bedside manner and approach with geriatric patients are likely very different from the approach needed to work with young children. However, many nurse case managers may find it easy to switch between these modes of working and may not feel the need to limit their work to a single population group.

Practice Setting

The final element of a nurse case manager's job likely to make a big difference is the healthcare environment where the nurse works. Working in a hospice means a nurse case manager will be working almost exclusively with individuals approaching the ends of their lives. A hospital may offer a wider variety of patient care opportunities. Some nurse case managers may also work for outpatient centers or with patients in their own homes.

All these factors can dramatically change what an individual nurse case manager does at work each day, even for two nurse case managers whose job titles are identical.

Nurse Case Manager Salary

One of the reasons some RNs choose to specialize in other areas of nursing is because the pay is typically higher. For nurse case managers, median pay is slightly higher than other registered nurses but not dramatically higher. According to recent data from Payscale.com, the median annual nurse case manager salary was $76,687 per year or $36.72 per hour. For regular registered nurses, the median pay was $32.20 per hour or $75,468 for an equivalent number of working hours per year. An RN case manager's salary will vary based on several factors, including work experience and work environment. The highest-paid 10% of nurse case managers made around $95,000 per year, according to the same data.

There are several ways to increase one's salary as a nurse case manager. The first is simply time: the longer one has worked in the field, the higher the pay is likely to be. Another major factor is the level of education. Those who pursue more advanced degrees or additional certifications may be eligible for a higher salary. Pay may vary from one healthcare facility to the next. Nurse case managers who want a higher salary may also be able to work their way up to more senior staff positions with a larger or more intensive client portfolio.