what is a case manager in nursing

How to Become a Nurse Case Manager | Salary & Guide 2024

What is a nurse case manager, how to become a nurse case manager.

• Career Outlook

 A nurse case manager, also known as a care coordinator, specializes in organizing and coordinating patient care and treatment by all members of the care team.

In most healthcare settings, multiple specialties and numerous doctors can attend to a single patient. Nurse case managers ensure everyone works as a team to provide the best care for the patient. This guide will cover everything you need to know about becoming a nurse case manager, including education requirements, certification, and salary expectations. 

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A case manager is a specialized registered nurse (RN) who works with patients and providers to determine the specific care required and the best options for that care. By collaborating with multiple specialties, RN case managers ensure patients receive quality medical care.

Since patient needs vary based on their condition, nurse case managers examine each case individually. They act as patient advocates to meet their patients' needs effectively and efficiently.

Nurse case management is also considered one of the easiest nursing jobs because of its hours. Many case management nurses work regular 8-hour days, unlike other types of nurses who work 12-hour shifts or have to be on-call. 

Nurse Case Manager Salary

The average annual nurse case manager salary is $98,869 or $48 per hour , according to ZipRecruiter . Salary.com reports similar data, stating that RN case managers earn approximately $94,892 annually. These estimates exceed the average RN salary in the US of $86,070 per year, as reported by the  US Bureau of Labor Statistics (BLS).

Nurse Case Manager Pay by Experience

You can increase your nurse case manager salary with experience. The longer you work in the field, the more you can earn:

• Entry level: $71,229 annually; $34.45 per hour
• Early-career: $74,322 annually; $34.89 per hour
• Mid-career: $78,366 annually; $37.03 per hour
• Experienced: $80,992 annually; $39.79 per hour
• Late-career: $83,779 annually; $40.68 per hour

Source: Payscale , Retrieved June 26, 2024

Highest Paying Cities for Nurse Case Managers

Case managers have reported the highest salaries in the following locations as of June 2024, according to ZipRecruiter :

Nurse case managers are often salaried, which means they have fewer opportunities for overtime. However, you can discuss overtime potential during your salary negotiations. If you land an hourly position, you can work overtime to maximize your nurse case manager income.

As with all jobs in the nursing field, earning potential increases with additional education and experience. Nurses typically receive a raise during annual employee performance reviews, and certifications can give nurses an additional bump in their paychecks.

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Step 1: Become a Registered Nurse

To become a nurse case manager, you first must become a registered nurse (RN). RN licensure requires graduation from an accredited nursing program. You can earn your RN license by earning a 2-year Associate Degree in Nursing (ADN) or a 4-year Bachelor of Science in Nursing (BSN).

You'll then sit for the national licensure exam, called the NCLEX-RN. Once you pass the test, you can apply for RN licensure with your state board of nursing.

Step 2: Gain Nursing Experience

Nurse case managers have a wealth of clinical experience that gives them the skills and qualifications they need to do their jobs effectively. Before pursuing an RN case manager position, you should acquire five years of nursing experience.

Step 3: Apply for Nurse Case Manager Jobs

As you earn experience, seek out entry-level case management jobs that allow you to work under the direct supervision of an experienced RN care coordinator. These roles can prepare you for certification and becoming a senior nurse case manager.

Step 4: Earn a Nurse Case Manager Certification

Nurse case managers can select from several certifications that demonstrate their skills and competencies, including:

• The Commission for Case Manager Certification (CCMC)
• American Case Management (ACM) certification
• ANCC Nurse Case Manager Certification
• Certification in Care Coordination and Transition Management (CCCTM)

Often, employers prefer candidates with verifiable skills in addition to experience. Earning one or more of these credentials can give you a competitive edge when applying for nurse case management roles. 

What Do Nurse Case Managers Do?

Nurse case managers are primarily in charge of coordinating patient care. Their duties include identifying the resources and services best suited for each patient. This work is crucial because it helps decrease hospitalizations for high-risk patients, streamlines care, and customizes treatment plans for individualized assistance.

The most common patient population cared for by nurse case managers are those with chronic health conditions like diabetes, heart disease, or COPD. You can expect to manage multiple patients simultaneously as an RN case manager. Additionally, you'll be assigned to those with chronic conditions that experience frequent hospitalizations or outpatient care visits.

Some of the most common nurse case manager duties include:

• Create and manage client-focused case management plan and long-term health care plan for patients with chronic or serious conditions
• Identify patient needs and connect them to available services and resources
• Develop a tracking system for patient care coordination and care management across the continuum, including care transitions, primary and specialty care
• Oversee systems for identifying high-risk patients through EMR, referrals, registries from health insurance payers
• Educate the client/family/caregiver about the case management process and offer guidance as they navigate complex medical decisions
• Partner with external case management programs to coordinate care
• Provide follow-up services to patients, including booking future appointments, following up on test results, and checking in after inpatient discharge or ED visits
• Act as clinical liaison for Payer Based Care Management programs

Where Do Nurse Case Managers Work?

Nurse case managers can work in various settings across the healthcare field. However, the most common workplaces for RN case managers include:

• Insurance Companies
• Long-term care facilities
• Medical supply companies
• Palliative care
• Community health centers
• Public health centers
• Oncology outpatient centers
• Outpatient clinics
• Home healthcare companies
• Government agencies

What are the Continuing Education Requirements for Nurse Case Managers?

As a career, RN case managers do not inherently have more CEU requirements than other RNs. Registered nursing licensure requirements vary by state, but often include a minimum number of education and clinical hours, along with a nominal fee.

However, if you pursue additional certifications to enter this career field, you may have to complete more CEUs per credential. Since each credential has individual requirements, there isn't a career-wide CEU standard. Instead, you can learn more about maintaining and renewing your nurse case manager certifications by contacting the accrediting organization or visiting its website.

What is the Career Outlook for Nurse Case Managers?

Based on current trends in healthcare and nursing, RN case management seems to be a steadily growing career field. 

The need for nurses continues to rise. In addition to the ongoing nursing shortage, the BLS predicts a growing need for this indispensable career field. By 2032, the organization predicts that the field will rise to 3,349,900 working nurses, a total growth of 6%.

However, healthcare trends may indicate a greater need for nurse case managers. The US has a growing aging population, which is the exact group RN case managers work with. As the pool of elderly patients with chronic health conditions expands, so will the need for nurse case managers.

Where Can I Learn More About RN Case Managers?

• Case Management Society of America
• American Case Management Association  
• Commission for Case Manager Certification  
• National Association of Case Management

Nurse Case Manager FAQs

What is an rn case manager.

• A case manager is a specialized RN who works with patients, usually with chronic health conditions, to coordinate their care during hospitalizations, outpatient appointments, and home care. 

What is the Average Salary of a Case Manager?

• The average annual nurse case manager salary is $98,869 or $48 per hour, according to ZipRecruiter .

What are the Five Components of Case Management?

• Care delivery and reimbursement methods, psychosocial concepts and support systems, quality and outcomes evaluation and measurements, rehabilitation concepts and strategies, and ethical, legal, and practice standards

What Qualities Should a Case Manager Possess?

• Strong time management skills, organization, effective communication skills, decision-making and problem-solving abilities, autonomy, teamwork, a creative personality, strong clinical skills and confidence

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• What Is a Nurse Case Manager

What Is a Nurse Case Manager?

Though the health care system has long emphasized preventive medicine as a means of controlling costs and improving outcomes, the 2010 passage of the Affordable Care Act (ACA) placed a renewed focus on measures that would cut costs and improve health outcomes. In turn, this has increased attention on how RNs can help keep people healthy while saving money.

Enter the role of nurse case manager—those RNs who leverage their medical knowledge and interpersonal and management skills to meet their patients’ health care needs.

What Does a Nurse Case Manager Do?

“Unlike other kinds of health care practitioners, case management nurses perform a variety of tasks across a wide range of disciplines,” says Tracy Towne , PhD, faculty member in the Purdue Global School of Nursing. “Alongside doctors and other health care professionals, they coordinate their patients’ care, advocating for them and getting them the services and education they need.”

Nurse case managers perform the following tasks:*

• Develop and manage the overall long-term health care plan for patients with chronic or serious conditions such as Alzheimer’s disease, diabetes, and heart disease.
• Book their patients’ doctor appointments and follow up to make sure they keep them.
• Serve as a resource for their patients, offering education and guidance to patients and their families as they navigate complex medical decisions.
• Act as a liaison between patients and their insurance providers to make sure they receive excellent health care at a fair price.

“Because nurses are trained to work on interdisciplinary teams and understand how to deal with patients’ psychosocial needs, they are the perfect choice to manage their care,” Towne says. “It’s a more holistic approach to care and services, and it is an incredibly valuable role when it comes to supporting those with chronic illnesses.”

Where Do Nurse Case Managers Work?

Case management nurses work in varied settings.

“They may work in acute care settings, with, say, someone getting a joint replacement or an organ transplant,” Towne says. “They would help that person manage their many appointments, treatments, and therapies. You also find them in ICUs, trauma units, burn units—in places where patients might take weeks to months to recover.”

You will also find these roles working in:

• Outpatient clinics
• Palliative care
• Community and public health centers

Many times, their specialty influences their choice of work settings. If, for instance, a nurse specializes in working with elderly populations, they may work in a rehabilitation center, home health care service, assisted living facility, or long-term care facility. Many case management nurses also operate as consultants, working with a variety of health care clients.

What Type of Education and Experience Is Required?

“Case management nurses are registered nurses, so they have either an associate’s or bachelor’s degree in nursing at a minimum,” Towne says. “Oftentimes, they are hired into a case management position. ASNs can work as nurse case managers, but generally, a BSN or above is wanted. Many will get a master’s degree down the line to increase their specialization in a particular area.”

One can become certified in nurse case management by the American Nurses Credentialing Center . To be eligible for certification, nurses must:

• Possess an active RN license
• Accumulate at least 2 years of full-time practice
• Complete a minimum of 2,000 clinical hours along with 30 hours of continuing education coursework within the field

Job Outlook for Nurse Case Managers

The U.S. Bureau of Labor Statistics doesn’t make employment projections for nurse case managers, but they do predict that employment of all registered nurses will grow 7% from 2019 to 2029, faster than the average for all occupations. Prospects are also positive for patient representatives, according to O*NET .

Among other factors, the ACA is expected to continue driving demand higher for preventative care health care workers, especially as millions of Americans continue to obtain health coverage.

Case management nurses play an instrumental role in supporting primary care practitioners as they help reduce overall medical costs by boosting efficiency, cutting unnecessary spending, and improving patient outcomes.

Earn Your Next Nursing Degree Online

If you’re interested in earning a higher degree as part of your journey to becoming a nurse case manager, look into the online nursing degree programs with Purdue Global. We offer an online RN-to-BSN degree, the Master of Science in Nursing , as well as the Doctor of Nursing Practice and a variety of postgraduate certificates. Request more information today .

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RN Case Manager: Job Description, Salary, and How to Become One

Dive into the dynamic world of Registered nurse (RN) case managers and learn about their responsibilities, salary expectations, and the steps to becoming one. Careers

• Rn Case Manager
• Table of Contents:
• Job Description
• Responsibilities
• Salary Expectations
• Becoming an RN Case Manager

Registered nurse (RN) case managers are dedicated healthcare professionals who work behind the scenes to ensure patients receive the best care possible. With their expertise in care coordination, resource utilization, and patient advocacy, they are the guiding hands that navigate the complex healthcare maze.

RN Case Manager Job Description

In healthcare, an RN case manager is pivotal in managing and coordinating the care of individuals with complex or chronic medical conditions. They are dedicated advocates, ensuring patients receive the most appropriate and timely healthcare services and resources. 

Through close collaboration with healthcare teams, patients, and their families, case managers develop and execute comprehensive care plans , schedule appointments and services, facilitate communication between healthcare team members, and closely monitor patient progress.

Care management involves four critical steps. First, there's the intake process, where the case manager gathers information about the client. Then comes the needs assessment stage, where the case manager digs deeper into the client's challenges and goals. Next is the service planning stage, which involves setting patient goals and creating an individualized treatment plan. Finally, the case manager monitors and evaluates the client's progress to ensure they are on track toward success. These steps help provide the appropriate support and achieve positive outcomes in care management.

The primary objective of an RN case manager is to promote optimal patient outcomes and ensure the highest quality of care through effective care coordination, resource utilization, and patient education.

Related: 11 Best Online RN to BSN Programs in 2023

Where Do RN Case Managers Work?

RN case managers work in both inpatient and outpatient settings. You can find these dedicated team members working in an array of healthcare venues, including:

• Long-term care facilities (LTACH)
• Assisted living facilities (ALF)
• Skilled nursing facilities (SNF)
• Insurance companies
• Community organizations

RN Case Manager Responsibilities

Case managers are essential in organizing and overseeing the care of individuals with medical or social needs. Their duties involve:

• Assess patient needs and develop individualized care plans
• Conduct assessments to determine patient eligibility for community resources, programs, or services
• Identify and address social determinants of health that may impact patient well-being
• Collaborate with healthcare teams; M.D.s, RNs, therapists, and social workers. 
• Participate in patient rounding and care conferences
• Coordinating healthcare services, appointments, and referrals
• Coordinating care transitions and discharge planning
• Providing patient education on treatment options, self-care, and preventive measures
• Ensuring accurate and up-to-date documentation of patient information and care plans
• Monitoring and evaluating patient progress and outcomes
• Managing and coordinating medication adherence and reconciliation
• Managing, ordering, and coordinating durable medical equipment (DME) patient needs.
• Assisting with insurance authorization and claims processes
• Monitoring and managing healthcare utilization and costs
• Advocating for patients and ensuring their rights and preferences are respected

Each case management position will look slightly different depending on the patient population and healthcare setting. The many responsibilities of a case manager showcase their diverse and crucial role in providing comprehensive and patient-centered care.

Benefits of Working as an RN Case Manager

Choosing a career as an RN case manager has many advantages. It allows you to impact people's lives positively by coordinating and enhancing their healthcare outcomes. As a case manager, you can experience personal satisfaction by advocating for patients, safeguarding their rights, and guiding them through the complicated healthcare system.

RN Case Manager Salary

As with any nursing position, the salary of a case manager in nursing will depend on various factors, such as your location, the healthcare facility you work for, the healthcare setting you work in, and your experience. 

As per recent findings from Ziprecruiter and Glassdoor , the standard annual income for case managers across the country is approximately $45,136 - $47,765.

Annual case management salary based on experience:

• 1-3 years CM experience: $48,927
• 4-6 years CM experience: $52,783
• 7-9 years CM experience: $55,867
• 10-14 years CM experience: $64,339
• 15+ years CM experience: $74,637

Annual Highest paying states for case managers:

• New York: $55,130
• Hawaii: $47,126
• Washington: $45,593
• New Hampshire: $45,315
• Indiana: $45, 254

Annual Lowest paying states for case managers:

• Illinois: $35,125
• Michigan: $35,058
• South Carolina: $34,332
• Texas: $34,332
• Louisiana: $33,351

Unfortunately, the  Bureau of Labor Statistics (BLS)  does not provide a detailed breakdown of RN salaries by specialty; thus, the data was sourced elsewhere.  

How to Become an RN Case Manager

If you aspire to become an RN case manager, here is a step-by-step guide on achieving your goal.

Step 1: Complete an Undergraduate Nursing Program

Obtain a BSN, Bachelor of Science in Nursing degree , to provide a strong foundation in nursing knowledge and skills. Technically, an associate degree-prepared RN may be eligible for case management positions, but most case management positions prefer RNs to have a bachelor's degree. This preference stems from the additional leadership and management training that comes with a bachelor's degree, making candidates more equipped to excel in the complexities of case management.

Related: 10 Best RN to BSN Programs in 2023

Step 2: Obtain Your RN License

After graduating from nursing school, you must pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN) to become a licensed registered nurse (RN).

Step 3: Gain RN Experience 

One way to gain valuable experience in a care management role is to work as an RN in a healthcare setting like a hospital, clinic, or nursing home. This experience will give you a better understanding of patient care and healthcare systems, which is essential for a case manager. Nursing experience may only be required for some nurse case management positions, but it is a solid foundation necessary for the role.

Step 4: Apply for an RN Case Management Position 

Look for case management job openings in healthcare organizations or insurance companies. Showcase your nursing experience and highlight your skills relevant to case management in your application.

Step 5: Advanced Education as an RN Case Manager 

Various certifications are available for RN case managers, including the Nursing Case Management Certification (CMGT-BC) through the American Nurses Credentialing Center (ANCC) or the Certified Case Manager (CCM) through the Commission for Case Manager Certification . Certification is not required for a case management position, but it does validate your knowledge and expertise in the specialty. 

If you're passionate about advanced education and case management, RN Case Managers also have the option to pursue an MSN with a concentration in care management. 

As an RN case manager, you hold the power to make a lasting impact on the lives of patients by coordinating their care with compassion and excellence. Embrace the opportunity to be a guiding hand, advocate for their needs, and navigate the complex healthcare system, knowing that your dedication and expertise can make a difference.

About Erin Lee , BSN, RN

Erin Lee has 12 years experience as a BSN, RN and specializes in Critical Care, Procedural, Care Coordination, LNC.

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How to Become a Nurse Case Manager

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Nurse case managers fulfill an important role in healthcare delivery. When patients have serious injuries or complex illnesses, navigating the many aspects of their healthcare can feel overwhelming. Nurse case managers help coordinate patients’ care, ensuring that they have the services and resources to support the best outcomes.

The following guide includes details about becoming a nurse case manager, including the required education, experience, and skills. We also cover what you might expect in this important role.

What is a Nurse Case Manager?

Nurse case managers coordinate care for geriatric patients and those recovering from a serious injury or navigating complex or chronic conditions. They may work in a hospital, long-term care facility, hospice, or for an insurance company. Regardless of where they work, nurse case managers are committed to ensuring patients get necessary and comprehensive care.

Case managers collaborate with other healthcare providers and payers to develop care plans for patients that offer the best results and value. This includes advocating for the patient, providing education, coordinating and monitoring the implementation of the plan, and communicating with all stakeholders.

For example, hospital case managers may help a patient access financial resources for care or develop a discharge plan and ensure the patient has access to follow-up care.

Steps to Becoming a Nurse Case Manager

Nurse case managers are experienced, licensed RNs. While it’s possible to qualify for an RN license with an associate’s degree, many employers prefer to hire nurses with at least a bachelor’s degree. However, once licensed, RNs can work under more experienced case managers, gaining the experience necessary to apply for board certification.

Earn an ADN or BSN Degree

Both ADN and BSN degrees prepare nurses to take the National Council Licensure Examination for Nurses( NCLEX-RN) exam for licensure. ADN programs typically require two years to complete, while the BSN is a four-year degree. Many employers require or prefer nurses with a BSN, and some states have pending legislation that requires nurses to hold a BSN.

Pass the NCLEX Exam to Receive RN Licensure

All nurses must pass the NCLEX-RN exam to qualify for a license to practice. The standardized exam covers patient care, ethics, and health promotion.

Gain Clinical Nursing Experience

Consider becoming a certified nurse case manager, nurse case manager education.

Because nurse case managers need a valid RN license, they also need a nursing degree. Although a two-year ADN degree is the shortest pathway to licensure, many employers require or prefer nurse case managers with four-year BSN degrees.

An ADN degree offers a faster path for someone who wishes to become a nurse and begin working in the field within two years. However, while the degree does meet the minimum eligibility for the NCLEX-RN and state licensure, some employers may prefer or require a bachelor’s degree for entry-level nurse case manager positions.

Admission Requirements

Requirements vary by program but generally include a high school diploma with coursework in science and math; a minimum 2.0 high school GPA; letters of recommendation; a personal essay; and SAT or ACT scores.

Program Curriculum

An ADN curriculum introduces students to the nursing profession, including performing health assessments, microbiology and immunology, and introducing nursing for specific populations (e.g., pediatric, medical-surgical).

Time to Complete

Skills learned.

ADN programs help prepare students for entry-level nursing practice and patient care. Specific skills include performing health assessments, nursing ethics, communication and collaboration, and providing patient education.

A four-year BSN degree prepares nurses for the NCLEX-RN and state licensure. This credential may be required or preferred by some nursing employers. A BSN also positions nurses to pursue advanced degrees and higher-level practice, along with greater earning potential. BSN programs include upper-level coursework to improve critical thinking and patient care skills.

Program requirements vary, but most include a high school diploma with a GPA of 2.5 to 3.0, a personal essay, letters of recommendation, and SAT/ACT scores.

BSN curriculum covers nursing practice, anatomy and physiology, pharmacology, nursing informatics, and research and statistics. Students also learn psychology, pathophysiology, leadership and management, ethics, and caring for specific populations.

BSN programs prepare nurses to provide high-quality, cost-effective patient care. In addition to developing bedside nursing skills, nurses are equipped with leadership, communication, and risk management skills to promote health and support good patient outcomes.

Nurse Case Manager Licensure and Certification

Nurse case managers must hold a valid RN license. State nursing boards determine the criteria to issue and renew RN licenses, so requirements to maintain license vary by state. Thirty-nine states require continuing education to renew a nursing license, and every state is different. Some states require specific courses, while others determine the number of hours based on experience. Visit AAACEUS for a list of state-specific requirements.

Although there is no legal requirement for a nurse case manager to be board certified, some employers may prefer or require the certification. Nurse case managers can earn the Case Management Nurse – Board Certified (CMGT-BC™) credential after two years of nursing experience and 2,000 hours of case management experience. The certification indicates that a nurse case manager has demonstrated competency in nursing and case management.

Working as a Nurse Case Manager

Nurse case managers can work in a variety of settings, including healthcare facilities and insurance companies. Case managers often begin their careers as bedside nurses and transition into roles that require more case management tasks. In many cases, nursing knowledge and experience can qualify you for entry-level case management positions that provide the experience necessary for certification.

Those working in clinical care settings like hospitals or nursing homes are closely involved in family education and support, discharge planning, and connecting patients with resources. Case managers working for insurance companies or other payers are likely to focus on developing care plans and coordinating care for complex cases.

According to Payscale , the average salary for a nurse case manager is $75,300. Although the Bureau of Labor Statistics does not list occupational information for nurse case managers specifically, they project that demand for medical and health managers will increase by 32% between 2020 and 2030. This is mainly attributed to an aging population increasing the demand for cost-effective healthcare.

Frequently Asked Questions About Becoming a Nurse Case Manager

How many years does it take to become a nurse case manager.

Nurse case managers must have a nursing degree, which requires at least two to four years of education. Certification requires at least two years of nursing experience, plus 2,000 hours of work experience as a case manager.

What is the quickest way to become a nurse case manager?

It is possible to become a nurse case manager with a two-year ADN degree and a nursing license. Most employers require case managers to have experience in nursing to take on entry-level roles, but the minimum years of experience varies. Look for positions that include case management responsibilities to gain experience.

What is the difference between a care manager and a case manager?

Nurse case managers focus on patient outcomes, developing cost-effective care plans in collaboration with clinical and nonclinical care providers. This might include discussing treatment options with providers and educating families, coordinating support from social workers and counselors, and following up to ensure that care plans are followed.

A nurse care manager, in contrast, focuses entirely on the clinical aspects of care, coordinating different providers to ensure the best and most cost-effective outcomes for all patients.

What skills are important to become a good nurse case manager?

Nurse case managers need to be organized and detail-oriented with excellent communication and collaboration skills. Case managers manage different perspectives and priorities with compassion and diplomacy, focusing on providing value and keeping costs in check.

Page last reviewed May 18, 2022

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Case management

An overview for nurses.

Armold, Sarah DNP, RN, ACNS-BC

Sarah Armold is an adjunct nursing professor at Colorado Technical University Online and a case manager at the University of Colorado Health in Fort Collins, Colo.

The author has disclosed no financial relationships related to this article.

Case management offers an exciting opportunity for nurses as they decide how best to serve their patients. This article discusses the role of case managers in the healthcare setting.

THE PATIENT PROTECTION AND Affordable Care Act (ACA) includes three primary goals: to decrease the cost and increase the availability of health insurance, to expand Medicaid, and to foster innovation of low-cost healthcare delivery models. 1,2 Many healthcare organizations have utilized case managers as a means of achieving these goals. 3 This article discusses the role of case managers in the healthcare setting.

With the advent of accountable care organizations (ACOs), which are groups of physicians, hospitals, or healthcare providers that offer high-quality, coordinated care, the ACA has led to a boom in case management. 4 According to the Commission for Case Management Certification (CCMC), the number of case managers rose from 27,000 in 2010 to 42,000 in 2017. 3 CCMC also reported that 32% of case managers work in ACO settings and that nurses make up to 89% of certified case managers. 3 Of all professional case managers, 67% have been involved in the profession for more than 10 years and 28% have advanced degrees. 3 These professionals are typically seasoned nurses who value continuing education (see Case manager certification requirements ).

Defining the profession

Case managers are defined consistently across different professional organizations. According to the Case Management Society of America, case managers “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.” 5 The Code of Professional Conduct for Case Managers states that these healthcare professionals support the Institute for Healthcare Improvement's Triple Aim of improved patient-care experiences, reduced healthcare costs, and improved population health. 6,7

Case managers work to meet patient needs through assessment, coordination, and planning, and by evaluating the available options and services. 6 Their involvement helps patients and caregivers make the best choices to manage the complex world of healthcare. Cost is a major concern, but case managers should not focus solely on reducing costs. Instead, as these professionals advocate for the patient, they can help extend cost savings and other benefits to support systems such as insurance companies and hospitals. 8

In 2009, the Healthcare Cost and Utilization Project estimated that 72% of patients discharged from hospitals were sent home without home health services. Additionally, discharges to home health services increased by 68% and discharges to long-term-care facilities increased by 34% between 1997 and 2009. 9 As such, certified case managers must be knowledgeable about community resources, routinely reaching out to determine how these resources are changing.

According to CCMC statistics, certified case managers work in multiple settings, including insurance companies (28.8%), hospitals (22.8%), workers' compensation (11.6%), and independent organizations (7.3%) such as home health services or private insurers. 10 As approximately two-thirds of these case managers work outside the hospital, they must remain experts in their local resources.

Although the CCMC data are unclear on the number of case managers working in patient homes, information is available to support in-home case management. For example, one literature review of community-based health programs demonstrated the efficacy of case manager home visits in decreasing healthcare utilization and improving quality of life in chronically ill older adults, as the following case study illustrates. 11

JH, 82, has diabetes, chronic obstructive pulmonary disease, and coronary artery disease requiring multiple percutaneous coronary interventions. He also has age-related hearing loss. His daughter had recently moved in to take over as his primary caregiver, but she passed away suddenly. Within a week, JH was admitted to the hospital with unresolved chest pain. He was discharged to home clinically stable with no medication changes. Because he was not clinically homebound, he was not eligible for home health services. When he got home, he struggled to follow up with primary care appointments and care for himself due to grief.

His case manager, who worked for the hospital and had been making home visits for about a year before JH's daughter passed away, continued to assist him. The case manager scheduled a primary care appointment and called one of JH's friends to ensure he had the necessary transportation. During the follow-up appointment, JH's case manager was able to answer provider questions on his behalf, pick up any new prescriptions, and deliver them to JH's home.

Because JH's family did not live nearby, the case manager contacted them and recommended hiring private caregivers to help with meals, clean the house, and provide companionship during this difficult time. His case manager also continued to visit JH at home to assess his condition and alert other healthcare providers as needed.

Opportunity to serve

Not all patients require in-home case managers for success in healthcare management, but those who are older, chronically ill, or have little support may benefit from a visit. Case management is an exciting field and may offer a great opportunity for nurses to better serve their patients.

Case manager certification requirements 12

Nurses and other members of the allied healthcare community can become case managers. To become certified, CCMC requires one of the following:

• a license or certification. Eligible healthcare professionals include RNs, certified rehabilitation counselors, certified disability management specialists, and licensed clinical social workers.
• a Baccalaureate or Master's degree in a health or human services field.

CCMC also requires experience as one of the following:

• 1 year as a case manager, supervised by a certified case manager.
• 2 years as a case manager, with certified case manager supervision not required.
• 1 year supervising case-management professionals.

Adapted with permission from: Commission for Case Manager Certification. CCM eligibility at a glance. 2019. https://ccmcertification.org/get-certified/certification/ccmr-eligibility-glance .

accountable care organizations; case management; case manager; home healthcare; Triple Aim

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Home / Nursing Careers & Specialties / Nurse Case Manager

Nurse Case Manager

What Is a Nurse Case Manager?

A case management nurse oversees the long-term care plan for his or her patients. Often working with a specific type of patient requiring ongoing medical care (e.g., geriatrics, HIV/AIDS, or cancer patients), the case management nurse collaborates with other medical professionals to create and implement a long-term care plan that insures a patient gets the comprehensive care they need. Case management nursing is a particularly rewarding field that allows nurses to develop long-term relationships with their patients, often working with them for the entire course of their illness and treatment.

Becoming a Nurse Case Manager

Once a nurse earns a nursing degree and secures an RN license, obtaining hands-on experience is the next step, often through an internship in case management. Many nursing students also have the opportunity to perform clinical rotations that include case management work. Prior to obtaining a full-time case management nursing position, many nurses seek to obtain a professional certification in case management from an accredited organization such as the American Nurses Credentialing Center.

A typical job posting for a case management nursing position would likely include the following qualifications, among others specific to the type of institution and patient population:

• Active RN license, BSN, or MSN preferred
• Minimum 1-2 years of professional nursing experience
• Professional experience in case management, utilization reviews, or discharge planning experience preferred
• Excellent interpersonal and communication skills for working with patients, caregivers, and medical teams on an ongoing basis
• Strong organizational skills, coupled with solid computer skills needed to coordinate appointments and maintain a patient's care plan

To search and apply for open case management nursing positions, visit our job boards .

What Are the Education Requirements for Case Management Nurses?

Most case management nurses hold a Bachelor's of Science in Nursing degree, which is a requirement for many case management nursing certifications. While a few employers may only require an Associate of Science in Nursing degree, applicants with a BSN likely have a competitive advantage. Case management nursing is also an option for advanced-practice nurses who hold a Master’s of Science in Nursing degree. All case management nurses must hold an active RN license, which can be achieved by passing the NCLEX-RN . Most hospitals and healthcare employers prefer case management nurses to have prior professional clinical experience.

Learn more about MSN in Case Management programs .

Are Any Certifications or Credentials Needed?

While not all healthcare employers require case management nurses to be certified, applicants with relevant certifications will certainly have an advantage when competing for case management nursing positions. The American Nurses Credentialing Center offers the Nursing Case Management Certification , the Accredited Case Management Credential is offered by the American Case Management Association and the Commission for Case Manager Certification offers the Certified Case Manager credential .

Eligibility requirements for these certifications vary and generally include a blend of education, practical training, and clinical experience.

Where Do Nurse Case Managers Work?

Case management nurses have the unique opportunity to work in a wide range of settings, including hospitals, clinics, and private practices. Case management nurses also work in facilities for patients with long-term medical issues such as nursing homes, hospice care facilities and home healthcare companies. Case management nurses interested in a high level of autonomy may also consider becoming independent case management consultants.

Nurse Case Manager FAQs

What is the role of a nurse case manager in an emergency room.

An emergency room is a fast-paced environment that includes a variety of staff including doctors, nurses, nursing assistants, registration/front desk, environmental service workers, laboratory staff, nurse practitioners, physician assistants, and in some hospitals, even a case manager.

A case manager in the emergency room is most commonly filled by a registered nurse due to their clinical experience. The essential job functions of the nurse case manager are to manage patients to the appropriate level of care (which may or may not include hospitalization), ensure optimum utilization of resources to promote cost-effectiveness, safe discharge planning, and the overall improvement of patient satisfaction in a timely manner. It is important to note that not all ERs require case managers due to their patient population.

Depending on the position, a case manager may be asked to complete a Utilization Review (UR). UR is the process of reviews and audits that ensure patients do not receive any unnecessary care to increase the cost of their healthcare.

Emergency room case managers have a unique role in that not all patients who enter the ER meet inpatient criteria for admission, but may require additional services for a discharge.

What Is Discharge Planning and Utilization Review?

Discharge planning is critical to health care. It helps to transition patients from the hospital to home by collaborating with the physician, bedside nurses, specialists, and other healthcare team members. Discharge planners review not only the physical needs of the patient but psychosocial and financial needs as well. They work to remove barriers that may delay recovery or healing while at home. For patients who are still need continuing care, they arrange for admission to a skilled nursing facility, rehab facility, or assisted-living facilities.

Utilization review nurses work to examine the cost efficiency of healthcare services while maintaining quality of care. They review medical records to ensure patients are not undergoing unnecessary and costly procedures and are not remaining needlessly in the hospital. They also help educate patients on their individual benefits plans,

Both discharge planning and utilization review overlap with case management. Case management nurses, as with discharge planners, work collaboratively with the healthcare team to meet the needs of the patient. However, while discharge planners focus on the transition out of the hospital, case managers focus on the entire stay as well as out in the community. Additionally, case managers also perform utilization review, ensuring patients are not over-utilizing resources unnecessarily while receiving the care they need.

Are Work from Home Opportunities Available for Case Management Nurses?

Case management nurses usually work in healthcare organizations such as hospitals and outpatient clinics. However, there are opportunities to work from home. Working from home allows case management nurses to have a high level of autonomy and flexibility

One career opportunity is as an independent consultant. Some companies (i.e., insurance companies) hire case management nurses to manage claims. Sometimes the case management nurse working as a consultant must still attend meetings and meet with clients, etc., so it may not always be 100% home-based.

Other case management positions allow telephonic work, but occasionally visiting patients may be required, and checking in at “the office” may also be required.

Case management nurses looking to work from home must be self-directed and learn how to be self-paced. It can be challenging to create your own workflow at home, and nurses must know how to “shift gears” when necessary as there is an intermingling of both work and home.  All in all, working from home allows for a healthy work-life balance once the case management nurse learns to structure their day to be able to complete their work and home responsibilities.

What Does a Nurse Case Manager Do?

Case management nurses partner with a patient and their medical teams to create and implement a long-term care plan tailored to the patient's specific illness, medical history, and lifestyle. An advocate for the patient and their caretakers throughout the course of their illness, case management nurses coordinate doctors' visits and surgeries, educate patients on their treatment options and the latest research, and often act as emotional support to patients in need of long-term care. Case management nurses often specialize in a specific group or type of patient; for example, working with patients suffering from cancer, diabetes, HIV/AIDs, Alzheimer's disease, or physical disabilities. Case management nursing offers a unique opportunity for nurses to develop deep connections with patients, often working with them throughout the full course of their illness.

What Are the Roles and Duties of a Case Management Nurse?

• Work with a team of medical professionals to develop and implement a comprehensive care plan based on the patient's illness and medical history
• Coordinate doctor's appointments and schedule surgeries
• Monitor medication usage by a patient
• Educate patients and caretakers on different treatment options and resources available to them
• Monitor and update treatment plans to reflect the latest in a patient's condition or lifestyle
• Research the latest treatments and procedures in their chosen area of specialization
• Work with insurance companies to help patients receive the most cost-effective care available
• Learn more about case management via our NCLEX-RN case management section

Nurse Case Manager Salary & Employment

Case management nurses make a median salary of $69,233 with a range of $54,565 – $86,446. Factors affecting a case management nurse's salary include geographic location, certification status, and education level as well as the type of employer (e.g., hospital, nursing home, or private practice).

The employment outlook for case management nurses is very positive, due to an increase in the aging population and the rising prevalence of medical conditions that require long-term care, such as diabetes and heart disease. There is also a wide range of employers looking for professional case management nurses, from hospitals and clinics to nursing homes and hospice care facilities.

Helpful Organizations, Societies, and Agencies

• Case Management Society of America
• American Case Management Association
• Commission for Case Manager Certification
• Collaborative Case Management

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HEALTHCARE CAREER GUIDES

Nurse case manager career, what is a nurse case manager.

Are you already a registered nurse and considering moving into another role where you can work with patients for the entire course of their treatments or illnesses? Or are you thinking of turning your passion for helping others into a career by earning your  nursing degree ? Either way, becoming a case manager is an excellent choice with great pay, fantastic job growth, and a fulfilling role that provides a holistic approach to health care.

Nurses are caring individuals that want to make a difference in people’s lives, and as a nurse case manager, you can make a huge impact. Often working with people that require ongoing medical care, RN case managers oversee their long-term care plan and can develop rich, rewarding relationships with these patients.

RESPONSIBILITIES

What does a nurse case manager do.

A nurse case manager develops, implements, and reviews healthcare plans for patients that are geriatric, recovering from serious injuries, or dealing with chronic illnesses. Case managers work both within and outside of a hospital or medical facility. And these registered nurses (RNs) collaborate with doctors and other medical professionals to give their patients the comprehensive care that they need. This includes advocating for their patients, coordinating their care, and providing other healthcare services and education.

Unlike specialized healthcare professionals, case management nurses perform a variety of tasks across a wide range of disciplines. Case management nurses are responsible to:

• Create and manage the plan of care for patients with chronic or serious conditions such as diabetes, heart disease, Alzheimer’s, and cancer.
• Advocate for personalized treatment options that address a patient’s unique care needs.
• Schedule their patients’ medical appointments and follow up to ensure they attended them.
• Communicate about a patient’s health condition with the patient and their family.
• Offer education and guidance for navigating complex medical decisions.
• Serve as a liaison between patients and their insurance providers to promote quality, cost-effective care with the best patient outcomes.

RN Nurse Case Manager Specialization

You’ll also have the opportunity to specialize in an area that you’re the most passionate about. Here are some of the most common case management nursing specializations:

• Patient specialty—focuses on a specific patient population such as the elderly (geriatrics) or children (pediatrics).
• Service specialty—focuses on a specific service area such as hospice, home healthcare, or rehabilitation.
• Duration specialty—focuses on the length of patient care such as short-term injury rehabilitation or long-term illness management.
• Disease specialty—focuses on patients suffering from a specific disease or chronic illness such as diabetes, cancer, substance abuse, or mental illness.

EDUCATION & BEST DEGREES

How do i become an rn case manager manager.

Pursuing a career in nurse case management often requires a higher degree. Enrolling in  Bachelor of Science in Nursing  programs is a good option for RNs looking to transition into a case manager position. However, if you’re new to the nursing field, you may want to start with a  nursing prelicensure program .

After finishing your bachelor’s degree program, you can further advance your career with a certification program from the  American Nurses Credentialing Center  (ANCC). This professional certification isn’t required for continued employment, but it makes you a better case manager, can increase your pay, and will make you more desirable for future job opportunities. To qualify you’ll need:

• An active RN license.
• Two years of full-time practice.
• 2,000 clinical hours.
• 30 hours of continuing education in your field.

Another way that you can progress your career as a case manager is to earn your master’s degree. WGU has seven master’s degree programs specific to nursing—all of which can be completed online. This is another great option for working registered nurses because they can fit in program coursework around their busy schedules. Our  RN-to-MSN  programs work well if you’re new to the nursing profession and want to get an advanced degree faster—which will increase your hire-ability within case management. For those who have earned their master's degree and want to further their education, the  post-master's certificate in nursing leadership & management  can be beneficial.

Best Degrees for a Nurse Case Manager

Nursing (Prelicensure) – B.S.

A one-of-a-kind nursing program that prepares you to be an RN and a...

A one-of-a-kind nursing program that prepares you to be an RN and a baccalaureate-prepared nurse:

• Locations:  Due to in-person clinical requirements, students must be full time residents of FL, ID, IN, IA, KS, KY, MI, MO, NV, NM, NC, OH, OK, SC, TN, TX, UT to enroll in this program. The coursework in this program is offered online, but there are in-person requirements.
• Tuition:  $6,430 per 6-month term for the first 4 terms of pre-nursing coursework and $8,755 per 6-month term for the remaining 4 terms of clinical nursing coursework.
• Time:  This program has a set pace and an expected completion time of 4 years. Certain coursework may be accelerated to finish faster.
• WGU offers the prelicensure program in areas where we have partnerships with healthcare employers to provide practice sites and clinical coaches to help teach you and inspire you on your path to becoming a nurse.
• If you don't live in one of our prelicensure states or don't qualify to apply, consider getting our  Bachelor's in Health and Human Services  instead. This degree allows you to work inside the healthcare industry, while also working directly with patients who need help.

Skills for your résumé that you will learn in this program:

• Community Health
• Women's and Children's Nursing

Nursing (RN-to-BSN Online) – B.S.

An online BSN degree program for registered nurses (RNs) seeking the added...

An online BSN degree program for registered nurses (RNs) seeking the added theoretical depth, employability, and respect that a bachelor's degree brings:

• Time: 61% of graduates finish within 20 months.
• Tuition:  $4,685 per 6-month term.
• Courses : 23 total courses in this program.
• Transfers: Students can transfer up to 90 credits.
• Healthcare Policy and Economics
• Information Technology in Nursing Practice
• Anatomy and Physiology
• Applied Healthcare Statistics

If you don't currently have an RN and don't qualify for your nursing prelicensure program, consider getting our Bachelor's in Health and Human Services  instead. This degree allows you to work inside the healthcare industry in a unique way.

Nursing – Leadership & Management (RN-to-MSN) – M.S.

This program for RNs includes a BSN component and is a substantial leap...

This program for RNs includes a BSN component and is a substantial leap toward becoming a nurse leader.

• Time: 62% of RN-to-MSN grads finish within 37 months.
• Tuition:  $4,685 per 6-month term during undergraduate portion and $4,795 per 6-month term during graduate portion.
• Courses : 32 total courses in this program.

Skills for your résumé you will learn in this program:

• Quality Outcomes in a Culture of Value-Based Nursing Care
• Nursing Leadership and Management
• Advanced Pathopharmacological Foundations
• Informatics for Transforming Nursing Care

If you're driven to lead, this online nursing degree will provide you everything needed to make that career a reality. This program is ideal for current RNs who are interested in earning both their BSn and MSN in an accelerated program.

Compare degrees

This program is not the only degree WGU offers designed to create leaders in the field of healthcare. Compare our health leadership degrees.

Nursing – Leadership & Management (BSN-to-MSN) – M.S.

For registered nurses with a bachelor's degree who are ready for...

For registered nurses with a bachelor's degree who are ready for additional career opportunities.

• Time:  61% of grads finish within 23 months
• Tuition: $4,795 per 6-month term
• Courses : 15 total courses in this program

This program is ideal for current RNs who have a BSN and are ready for the next step in their education.

Nursing Leadership and Management – Post-Master's Certificate

A certificate for registered nurses with a master's degree in nursing who...

A certificate for registered nurses with a master's degree in nursing who are ready for greater responsibility in a leadership and management role.

• Time:  Students typically finish this program in 12 months.
• Tuition:  $4,795 per 6-month term. The cost to sit for the NAHQ Certified Professional in Healthcare Quality (CPHQ) exam is included in tuition.
• Courses : 8 total courses in this program.
• Strategic Planning
• Resource Management
• Business Case Analysis
• Evaluating Healthcare Improvements

Psychiatric Mental Health Nurse Practitioner (BSN-to-MSN) – M.S. Nursing

This program for BSNs who have an active, unencumbered RN license prepares...

This program for BSNs who have an active, unencumbered RN license prepares you to become a board-certified Mental Health Nurse Practitioner.

• Locations:  Due to the clinical requirements of this degree program, the PMHNP program at WGU is currently NOT open to students who have a permanent residence in the following states: Arizona, California, District of Columbia, Louisiana, Maryland, Massachusetts, New York, North Dakota, Oregon, Tennessee, Washington, and Wisconsin.
• Time:  It takes 2.5 years to complete the coursework and clinical components of this degree program.
• Tuition and fees : $6,625 per six-month term.
• Courses: 17 total courses in this program.

This program is for current RNs who have earned their BSN and are ready to move forward in their career. This MSN program prepares students to become licensed as a Psychiatric Mental Health Nurse Practitioner in select states.

• Advanced Pathophysiology 
• Assessment and Diagnostics
• Behavioral health
• Advanced Pharmacology

Students must have a permanent and active license from a state that is not listed above, must complete the internships in that state, and intend to obtain initial APRN licensure in that state. See more  state-specific information related to nursing licensure . Compact licenses must be endorsed by your state of residence. More  about compact licenses .

Psychiatric Mental Health Nurse Practitioner – Post-Master's Certificate

This program is for current RNs who already have earned an MSN and are...

This program is for current RNs who already have earned an MSN and are wanting to become a Psychiatric Mental Health Nurse Practitioner through a post-master's certificate program.

• Locations:  Due to the clinical requirements of this degree program, the PMHNP post-master's certificate program at WGU is currently NOT open to students who have a permanent residence in the following states: Arizona, California, District of Columbia, Louisiana, Maryland, Massachusetts, New York, North Dakota, Oregon, Tennessee, Washington, and Wisconsin.
• Time:  This program can be finished within 1.5 years, depending on transfer credit and how quickly you move through core coursework. Please note the clinical components of this program are set. 
• Tuition and fees : $6,625 per six-month term.
• Courses: 11 total courses in this program.

This program is for current RNs who have earned their MSN but are wanting to add a specilization to become a psychiatric mental health nurse practitioner. This post-master's certificate program is only available in select states.

How Much Does a Nurse Case Manager Make?

According to the  Bureau of Labor Statistics , the median average salary for a registered nurse is $81,220. That’s nearly double the salary of the average U.S. worker! Nurse case managers enjoy a good salary, along with many added benefits, including overtime and retirement pay, health insurance, paid time off, and flexible scheduling.  

What Is the Projected Job Growth?

As for their job outlook, qualified RNs are more in demand than ever due to a  nationwide nursing shortage . In fact, jobs for registered nurses across all disciplines are predicted to grow by 6% over the next 10 years. Case managers, in particular, may experience an even faster growth rate because they’re becoming an invaluable asset in helping our healthcare system find a balance between patient needs, costs, and resources.  

What Skills Does a Nurse Case Manager Need?

Case managers need many skills and attributes beyond those common to traditional nursing care roles. They must be able to work autonomously and make quick decisions. They also need to be excellent communicators to effectively relay critical information to their patients, clinical teams, and insurance providers.

Here are other top skills of successful case management nurses:

Time management

Organization

Clinical practices

Cultural sensitivity

Political savvy

Conflict resolution

Problem-solving

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What Is a Nurse Case Manager? Outlook and Path

Registered nurses (RNs) take on many critical roles in the healthcare system. They care for patients with acute and chronic health conditions, perform diagnostic tests, and educate patients on managing their health. Nurses also act as case managers. What is a nurse case manager though?

Nurse case managers connect patients with healthcare services. As patient care coordinators, case managers help patients meet their health needs while also advocating for patient safety and care quality.

Case management roles provide work-from-home opportunities and the potential for higher earnings. Experienced nurses who hold an advanced nursing degree can pursue careers as nurse case managers.

Nurse Case Manager Job Responsibilities 

While most registered nurses provide clinical care for patients, a nurse case manager is more focused on administrative responsibilities. Case managers coordinate care for patients, acting as a liaison between patients, insurers, and healthcare providers.

Effective nurse case managers help patients and their families understand their medical options. Patient education represents a key job responsibility for nurse case managers. 

Nurse case managers bring clinical skills to their role. Depending on the setting, they may perform health assessments or evaluate patients. Most jobs require a valid RN license.

Depending on the workplace, case managers may also be called care managers, care coordinators, or patient advocates. Specialized roles include hospital case manager, home health case manager, health insurance case manager, and rehabilitation case manager.

Case Manager Work Settings

Nurse case managers work in several employer settings. According to a 2022 survey by the Case Management Institute (CMI), 41% of case managers work in managed care or health plans, while 31% work in hospitals and acute care settings. They also work in outpatient care, rehabilitation, behavioral and mental health, and other healthcare settings.

Case managers also work in several different workplace environments. While around half work in clinical and office locations, 49% report working from home, according to the CMI survey. 

The responsibilities of nurse case managers often include traveling to connect with patients and other healthcare providers. They may also include educating patients and members of the community in various settings. 

Key Case Manager Skills

Nurse case managers rely on their communication and organizational skills to connect patients with care providers and coordinate care. For example, case managers regularly interact with patients, family members, insurance agents, and healthcare professionals. Strong communication skills allow case managers to effectively advocate for patients.

Because nurse case managers often take on a caseload that includes multiple patients, the role requires an organized and detail-oriented approach. The ability to create action plans, educate patients, and comply with regulations also benefits nurse case managers.

Steps to Become a Nurse Case Manager 

Careers in case management require a mix of education and experience. For example, a majority of nurse case managers hold a bachelor’s degree and professional certification, according to the CMI report. The steps below prepare candidates to become nurse case managers.

1. Become an RN

A licensed RN is an essential part of what a case manager is. Currently, 86% of case managers are RNs, while social workers make up 9% of case managers, according to CMI. 

Nurses need at least an Associate Degree in Nursing (ADN) or, less commonly, a nursing diploma to become an RN. After completing coursework and clinical requirements, candidates must pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN) and apply for their RN license through their state board of nursing.

2. Earn a BSN or an MSN

Most case managers hold a bachelor’s degree or a graduate-level degree. Just 15% of case managers have an associate degree as their highest level of education, while 52% hold a bachelor’s degree and 30% hold a master’s degree, according to CMI. This indicates that earning a Bachelor of Science in Nursing (BSN) or a Master of Science in Nursing (MSN) can help RNs become nurse case managers. 

RNs with an ADN can advance their education through an online RN to BSN program , which can be completed in as little as 15 months (with required prerequisites). RNs who already hold a BSN can enhance their credentials by enrolling in an online MSN program , which can be completed in as little as 15 to 18 months. Prospective nurse managers who are not already RNs may enroll in four-year BSN programs or BSN completion programs, which can be completed in as little as 21 months (with required prerequisites).

3. Gain Work Experience

Case managers typically bring several years of clinical experience as a nurse. They may work in hospitals, community health organizations, or other healthcare settings. Patient care experience helps nurses build the communication skills required for careers in case management.

Experience in patient care coordination or discharge planning benefits prospective case managers. Similarly, gaining leadership and management experience helps RNs move into case manager roles. 

4. Apply for Board Certification

While professional certifications are voluntary, they can help nurse case managers expand their career opportunities. For example, 67% of respondents in the CMI survey held a professional certification. The survey also found that 33% of employers required certification, while 32% encouraged but didn’t require certification.

Nurses can pursue board certification in nursing case management. The American Nurses Credentialing Center (ANCC) offers the case management nurse – board certified (CMGT-BC) credential to RNs with at least two years of full-time experience and at least 2,000 hours of clinical practice in nursing case management.

Candidates for the ANCC credential must pass a 150-question exam. The certification remains valid for five years.

Demand for Nurse Case Managers

As the population continues to age, demand for healthcare services will increase. RNs will see an estimated 193,100 job postings annually from 2022 to 2032, according to projections from the U.S. Bureau of Labor Statistics (BLS).

Case managers will likewise benefit from strong demand. Patient care coordination will continue to be a key responsibility in hospitals, insurance agencies, and other settings. 

Become a Nurse Case Manager With Denver College of Nursing

RNs can advance their careers and gain flexibility in their work schedules by moving into case management. Take your first steps toward becoming a nurse case manager by earning an advanced degree from the Denver College of Nursing. 

Registered nurses can enroll in the RN to BSN or MSN online programs to advance their education. Or individuals can enroll in the BSN completion option if they hold a bachelor’s degree in a non-nursing field. Learn more about what a nurse case manager is and how the Denver College of Nursing can help you achieve your career goals.

Recommended Readings Creative Ways to Show Exemplary Leadership in Nursing Keep Learning: Five Nursing Certifications to Consider Once You Graduate What Is a BSN Completion Program and How Does It Work?

Sources: American Nurse Journal, “Exploring Nurse Case Manager Practice” American Nurses Credentialing Center, Nursing Case Management Certification (CMGT-BC)  Association of Rehabilitation Nurses, What Does a Rehabilitation Nurse Case Manager Do? Betterteam, “RN Case Manager Job Description” Case Management Institute, 2022 Case Management Salary and Trends Survey U.S. Bureau of Labor Statistics, Registered Nurses Verywell Health, “Duties and Types of Case Managers”

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Pros and Cons of Being a Registered Nurse Case Manager + Salary + Steps to Become

Registered nurse case managers primarily work in an administrative capacity, coordinating care for long-term patients facing multiple hospital admissions, as is often the case with geriatric patients, patients recuperating from serious injuries, or patients affected by chronic conditions like Alzheimer’s, cardiac disease, or diabetes. RN case managers organize the different services a particular patient will receive by developing care plans that are specifically tailored to those patients’ needs. Think of a nursing case manager as a cross between a social worker and a clinician. This article offers an in-depth look at the position of registered nurse case manager – what is it, how to become, salary, and the pros & cons.

What Does a Registered Nurse Case Manager Do?

• Assess client needs • Create care plans • Coordinate between clients, care providers, and facilities • Make sure clients and client caregivers understand treatment options • Communicate regularly with clients and client caregivers to ensure treatments are meeting client needs • Serve as a liaison with appropriate human service agencies • Serve as a liaison with insurance providers • Review utilization of services • Participate when appropriate in discharge planning

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What Is The Average Salary Of A Registered Nurse Case Manager?

How Much Does The Registered Nurse Case Manager Salary Grow With Experience?

What Benefits And Perks Can A Registered Nurse Case Manager Expect?

• healthcare insurance:, • paid time off:, • retirement contributions:, • mileage reimbursement:, average salary of a registered nurse case manager in your state.

Highest Paid Registered Nurse Case Managers

What are the 10 highest paying states for rn case managers.

What Are The 10 Highest Paying Metros For RN Case Managers?

Registered Nurse Case Manager Job Outlook

Is there a demand for rn case managers, why is there a demand for rn case managers, most common interview questions and answers for rn case manager jobs, question #1: how do you manage a heavy case management workload, what the interviewer really wants to know:, sample answer:, question #2: how do you establish rapport with the families of your clients, question #3: how do you evaluate the care your patients may have received from other professionals on your case management team, question #4: tell us about a time when you had to explain complex information to a client., question #5: where do you see yourself in five years, useful resources for registered nurse case managers, organizations and associations, websites/blogs, youtube videos, bonus a typical day in the life of a rn case manager, 9:00 a.m. – 10:00 a.m.:, 10:00 a.m. – 11:00 a.m.:, 11:00 a.m. – 1:30 p.m.:, 1:30 p.m. – 2:00 p.m.:, 2:00 p.m. – 3:30 p.m.:, 3:30 p.m. – 5:00 p.m.:, 5:00 p.m. – 6:00 p.m.:, my final thoughts, frequently asked questions answered by our expert, 1. is becoming an rn case manager a good career choice, 2. is it hard to become a registered nurse case manager, 3. is nurse case management stressful, 4. do nurse case managers make good money.

5. What Is The Difference Between An RN Care Manager And RN Case Manager?

6. on average, how much does a registered nurse case manager make per hour.

7. Do RN Case Managers Make More Than Floor Nurses?

8. in which settings do nurse case managers earn the most, 9. do i need to be an rn to be a case manager, 10. can i become a nurse case manager with no experience, 11. what does an rn case manager do in home health, 12. what is the role of a nurse case manager in an emergency room, 13. as a case management nurse, can i work from home, 14. what exactly does a work-from-home case management nurse do.

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Duties and Types of Case Managers

Responsibilities, hospital case manager, home health case manager, health insurance case manager, becoming a case manager, a word from verywell.

Has your health insurance company assigned you a case manager? Are you being seen by a case manager in a hospital or home health company? Are you a nurse who wants to become a case manager?

If you are not sure what a case manager does, why you need one, or whether you'd like to become one, this article will explain some basic information that you need to know.

First, you should know that what a case manager does depends on the setting in which they work. For example, a case manager working for a home healthcare company will be providing very different services than a case manager at a health insurance company, workers' compensation insurance company, or hospital.

However, there are certain things consistent across all case management roles.

Case management involves the assessment of a client's needs and the linking of that client to the available services and resources. As such, the case manager works as a facilitator rather than a provider of client services.

Particularly for chronic medical conditions, case management can result in better patient outcomes, better compliance with medical advice, and better patient self-management, although there are limits to the impacts that case management can have. Here are some examples of what a case manager does in different settings.

A hospital case manager is usually a nurse who does both utilization review and discharge planning. Utilization review involves making sure that a patient is getting care that’s medically necessary and getting it in the correct setting.

Discharge planning is the process of predicting the patient's continuing medical needs after they leave the hospital and putting in place a plan to meet those needs. Hospital case managers are masters at organizing complex care needs across time and providers .

One of the key roles of a hospital case manager is to assess the patient's health insurance plan and to work with the insurer and multiple medical providers to ensure that the best care is delivered with the least financial burden.

For example, it’s the hospital case manager that makes sure a patient’s health insurance company understands what’s happening during the patient’s hospitalization.

The case manager would also make sure that the insurer has all the information it needs to approve payment for the hospitalization and works to prevent insurance claim denials . The hospital case manager will typically communicate with the health insurer’s case manager every day or every few days.

The hospital case manager is also the one who arranges for a patient to have home visits from a visiting nurse after being discharged from the hospital or to get intensive stroke rehabilitation from an inpatient rehabilitation facility. The case manager will help the patient pick a home health company that’s in-network and that will accept them as a patient.

Additionally, a hospital case manager may negotiate coverage benefits between a health insurer, provider, and patient.

Here’s an example: Say, a patient with a chronic bone infection is healthy enough to go home and obtain home antibiotic infusions for the next three weeks. However, the health insurance policy doesn’t cover the intravenous (IV) drugs or equipment for home-based care.

The case manager may end up negotiating with the pharmacy, home healthcare company, health insurer, and the patient. In some cases, the patient may have to pay some out-of-pocket expenses, but it will be far less than what it would cost to stay in hospital. By negotiating with all parties, the case manager can help to keep costs lower.

Hospital case managers are sometimes referred to as care coordinators or patient advocates, depending on their specific role. In any case, they can serve as a valuable resource for the patient, the hospital, and the patient's health plan.

A home healthcare case manager differs from a hospital case manager in that the manager often provides hands-on care. In addition, the case manager coordinates the services of other members of the healthcare team and caregivers, communicates with the health insurance company, communicates with the patient’s physician, and supervises visiting nurses and other home health aides who provide support.

With input from the patient and family, the home healthcare case manager develops that patient’s plan of care and presents it to the patient’s physician for final approval. The case manager will also coordinate the implementation of the plan with the client and service provider and make tweaks to the plan when needed.

While home health case managers are usually nurses, some are not. It is important, therefore, to establish whether the home health company you're hiring provides nursing care or only basic home assistance.

The health insurance company’s case manager receives information from hospital case managers, home healthcare companies, physician’s offices, social workers and other healthcare providers. Depending on the insurer and the location, the case manager may even visit a patient in the hospital.

The goal of health insurance case management is to make sure the patient is getting medically necessary care, quality care, and that the care is being delivered as efficiently and economically as possible. The case manager also anticipates the patient’s future healthcare needs and tries to put in place mechanisms to meet those needs as efficiently as possible.

In some health insurance companies, the job may be focused on a specific chronic disease. For example, if working with people with HIV, the case manager would ensure that monthly medications are received properly, the optimal adherence is achieved, that routine blood tests are scheduled, and any side effects or complications are noted so that providers can be coordinated.

Within this context, any shortcoming in case management can have direct and potentially dire consequences for the patient.

Case management is typically done by nurses, but not always. Depending on the setting, another type of professional may provide case management services. For example, the person providing case management services in a substance abuse rehab facility might have a background in substance abuse counseling. It’s not uncommon for case management to be done by medical social workers.

Hospital case managers must hold a license or certificate in a health or human services discipline (such as nursing or social work) and have field experience of 12 to 24 months before official certification can be obtained.

If you want to become a case manager, you'll need to understand the education, licensure, and certification requirements in your state and for the particular organization where you hope to work (ie, an insurance company, a hospital, a home healthcare company, etc.). In most cases, you'll need a background in a field such as nursing or social work, but the specifics will vary depending on the job you're seeking.

Those underlying professions have their own licensing requirements, overseen by state medical boards and regulatory departments. Since medical licensing is done on a state-by-state basis, this can get complicated if the organization employing the case manager has clients in multiple states.

For example, nurse case managers must maintain their nursing license in any state where they are providing services. Depending on the scope of the organization that employs the nurse case manager, this may involve obtaining multiple state licenses, or participating in a multi-state compact in which states recognize the nursing licenses provided by other states.

In addition to the underlying education and professional licensure, most states and employers will require certification in case management. For example, you may need to get a CCM (Certified Case Manager) certification from the Commission for Case Manager Certification , or an ACM (Accredited Case Manager) certification from the American Case Management Association .

If you're a social worker, your certification might be as a Certified Social Work Case Manager (C-SWCM) or a Certified Advanced Social Work Case Manager (C-ASWCM), which can be obtained from the National Association of Social Workers . (Note that Commission for Case Manager Certification and the National Association of Social Workers have a collaborative agreement that allows social workers to take the CCMC certification exam without an additional fee).

You'll want to clearly understand the education, experience, licensure, and certification requirements for the job you're seeking, as they will differ from one state to another and from one job to another.

According to PayScale, the average nurse case manager in the United States earns $72,983/year in 2023. But for case managers who are not nurses, average salaries tend to be lower, with the overall average income for a medical case manager at a little less than $56,000 as of 2023.

A case manager's job differs depending on whether they work for a hospital, home health agency, or health insurance company. But in general, case managers ensure that patients receive well-coordinated, medically necessary care, and that all involved parties (health plan, medical providers, and the patient) are kept in the loop and on the same page.

If a case manager has been assigned to your medical care, they can be a helpful resource in terms of making sure that you're receiving the care that you need and that your health insurance plan is being kept updated on the specifics of your treatment. They can also help to coordinate care and ensure that you stay healthy after a hospital stay, to reduce the chances that you end up needing to return to inpatient care.

Case Management Society of America. Multi-State Nursing Licensure .

National Association of Social Workers. NASW, CCMC collaborate to address growing demand for health care case managers . June 21, 2016.

PayScale.com. Average Nurse Case Manager Salary .

PayScale.com. Average Medical Case Manager Salary .

By Elizabeth Davis, RN Elizabeth Davis, RN, is a health insurance expert and patient liaison. She's held board certifications in emergency nursing and infusion nursing.

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Case management.

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Last Update: August 14, 2023 .

• Definition/Introduction

Case management is defined as a health care process in which a professional helps a patient or client develop a plan that coordinates and integrates the support services that the patient/client needs to optimize the healthcare and psychosocial possible goals and outcomes. [1]  The case management process helps the patient and their family navigate through a complicated set of services and supports available within a benefit plan, an organization or institution, and their community. Concerning cost-effective outcome analysis, Hudon et al. found that approximately 10% of patients account for approximately 70% of all healthcare expenditures. [1]  Statistics show that 5% of emergency department patients account for 30 to 50% of emergency department visits and these high utilizing patients may unsuccessfully attempt to meet their healthcare and related needs on their own which often is ineffective, characterized by overutilization of expensive, or underutilization and uncoordinated effective health care and social services. [1] [2]

Case management is often a part of other healthcare activities embodied in terms such as care management, care coordination, and disease management. All these terms have overlapping definitions and identities. Case management is a fundamental element of these other activities. Care management, frequently used in the payer context, is somewhat of an umbrella term and describes a program composed of a broad set of activities and tasks that include the healthcare-related aspects of case management but also extends to a wide array of services, supports, benefits, and entitlements spanning many domains to which the patient/client may have access, including healthy lifestyle programs, recreational activities, and social enrichment programs within a benefit plan. [3]

Care coordination also encompasses the activities and tasks included in case management but is seen in a broader programmatic context and frequently is discussed in the population health context as a means for an organization or institution pursuing population health strategies to manage the many needs of a population of patients, often by determining specific sub-groups who should receive case management services. [3]  In contrast to care management and care coordination, disease management is a narrower form of case management. It typically is case management directed at particular patient groups who all share a common diagnosis or condition. For example, patients with arthritis or patients after joint replacement surgery may be offered a discrete disease management program for a specific period. [3] Those professionals who conduct case management are described as service brokers, service coordinators, or system navigators. [4]

Since health care is often likened to a journey, other metaphors like travel companion, travel agent, and travel guide are used that attempt to capture not only the centrality of case management to the health care journey but also the need for navigational assistance in helping to shape the itinerary of the health care journey for the patient/client. [4]

The components of case management are many. Hudon et al. summarize several descriptions of case management including those from the Case Management Society of America and the National Case Management Network of Canada and describe six core elements which include patient identification and eligibility determination, assessment, care planning along with goal setting, plan implementation, plan monitoring, and transition and discharge. [2]  Ahmed and Kanter, also summarize similar case management core element lists. [3] [4]  However, case management descriptions may go beyond these six core elements and include additional activities and tasks that comprise case management. [3] [4]  

In a literature review, Lukersmith et al. identified 79 articles that identified 22 definitions of case management, described five models, and delineated 17 key components to case management comprising 69 activities and tasks that include and build upon the six core elements. [5]  This variability in both the definition and description of case management may lead to an amorphous sense of case management in a given healthcare initiative. It may also contribute to potential role confusion and ambiguity among those who conduct case management activities and tasks. The 17 key components identified in the literature review include: case finding, establishing rapport, assessment, planning, navigation, provision of care, implementation, coordination, monitoring, evaluation, feedback, providing education and information, advocacy, supportive counseling, administration, discharge, and community service development. [5]

Since case management is so encompassing as a concept and a set of activities and tasks in health care, there are many perspectives from which to understand and view case management. Case management may be used by health insurers/payers, hospitals, health systems, physician practices, and community health organizations. Also, case management may be directed at broad populations of patients in primary care with various chronic conditions or a more narrowly defined population of patients affected by a specific clinical circumstance or disease, such as patients with brain injury. Case management goes from the identification and engagement of patients/clients through the assessment and care planning steps and culminating in monitoring the care described in the care plan and ultimately achieving the targeted outcomes in a measurable manner. The fundamental ingredient to case management is the planning of care, which results in a care plan that essentially is the roadmap for a given patient/client to navigate through.

• Issues of Concern

Case management encompasses a wide range of activities; therefore, it is challenging to define case management as a discrete intervention precisely. Besides, the definitional variability of case management and the clinical setting in which case management occurs is also ample. Lukersmith et al., in their review of 79 articles, identified a variety of service sectors and service settings that utilize case management. [5] The service sectors include health, social, correctional, vocational, veterans, and legal sectors. The service settings include public, private, and non-governmental organizations that could be further stratified by the number of resources and support. [5]

Depending on the service sector and the service setting, case management occurs across a continuum of involvement ranging from a relatively brief episodic type interaction that might be offered to a patient during and after an inpatient orthopedic procedure to a much more holistic, longitudinal interaction as might occur in the context of a patient with a severe mental health disorder who is served by a community-based organization over many years.

The evolving and expansive nature of what to include in case management has led to variability definitions and variability in what constitutes a case management intervention. This ambiguity is often observable in the literature. Hudon et al. conducted a systematic analysis involving 21 articles and 89 other related documents and identified at least five different service delivery configurations classified as case management in the healthcare setting. [6]  Lambert et al. characterize current literature on case management as somewhat of a black box, and propose that case management is so complex and variable in practice and definition, that it should be considered a process that unfolds that links interconnected actions within a complicated, adaptive health care system. [7]

• Clinical Significance

The case management process occurs over time and in the context of a relationship among the patient/client, the case manager, and the various healthcare providers and organizations that interact and provide services and supports. Case management's process unfolds as the six core elements to case management are operationalized for a given patient/client in their specific clinical context. The six core elements are included in the long lists of the 17 components identified by Lukersmith et al. and are described below. [5]

• Patient identification and eligibility determination: Case finding describes a process involving activities focused upon the identification of patients/clients not currently receiving case management services. Establishing rapport consists of building an interpersonal connection between the case manager and the patient/client.
• Assessment: Assessment refers to construct a detailed, comprehensive understanding of the patient/client which includes, their healthcare and social needs, their capabilities, and the resources they have access to in their family and community.
• Care planning along with goal setting: Planning encompasses the steps necessary to build a care plan that defines treatment goals, tasks and actions needed to move towards those goals, access to specific services and supports required to achieve the stated goals and final the identification of targeted outcomes that are specific to that the patient/client. Navigation encompasses the part of the case management process where the case manager helps guide the patient/client to services and supports recognizing and working to remove barriers that can either be anticipated or those that unexpectedly arise. Provision of care occurs when the case manager is also part of the treatment team as might happen in the mental health setting. For example, where the patient' s/client's case manager might also be part of the therapy team providing counseling and skills training.
• Plan implementation: Implementation, is the part of the case management program where the plan of care with its varied activities and tasks, is set in motion. Coordination is related to navigation but is broader and refers to the myriad of facilitations that must occur between and among care providers, service settings, organizations, and institutions with the patient/client also being the focus and at the center of this component of the case management process.
• Plan monitoring: Monitoring occurs throughout the entire process and is related to seeking ongoing feedback and conducting follow-up as necessary to how the plan of care is being implemented and producing results. Evaluation is closely related to monitoring but occurs at specific milestones during the case management process to formally determine if the care plan helps the patient/client achieve progress towards goals and outcomes. Feedback as a component of case management involves communication back to service providers about their services' effectiveness. It supports in assisting the patient/client in making progress as defined in the plan of care. Providing education and information encompasses helping the patient/client and their family/support system develop a deeper understanding of relevant health and health care topics. Advocacy refers to activities directed at empowering the patient/client to pursue services and supports and related accommodations and proper entitlements to their circumstances. Supportive counseling describes the case manager's effort to consistently provide encouragement and emotional support as the care plan unfolds. Administration encompasses the paperwork, report writing, and data gathering and analysis that are part and parcel of the modern health care system.
• Transition and discharge: Transition describes the process when a client is prepared to move across the healthcare continuum, depending on the patient's health and the need for services. The client can be moved home or transferred to another facility for further care. Discharge represents the case management process component in which the patient's/client's case reaches the point of closure, goals are met, and the patient's needs warrant disengagement with the case management process. Finally, community service development occurs when the case management process uncovers a need or service gap within a given community. Then the case manager catalyzes efforts to create that service or support to fill that gap.

Case management is about helping patients coordinate and navigate through their health care in a cost-effective manner. Hudon et al. identified a set of 5 patient-centric positive outcomes that include improvement in self-management skills, care plan adherence, satisfaction, self-reported health status, and perceived quality of life. [6]  They also identified two system-level outcomes: a reduction in overuse and cost and improvement in measured quality of care. A year earlier in a related article, Hudon et al. described a list of positive outcomes that spanned patient and system-oriented parameters which included: health status, functional status, patient satisfaction, self-management, emergency department visits, clinic visits, hospital admissions, hospital length of stay, and inpatient costs. [1]

In this review, positive outcomes were most likely to be documented in case management interventions that included high-intensity interventions (i.e., case management described by small case-loads, face-to-face contacts were frequent and the first assessment occurred in person) were offered to the patients/clients as well as when multi-disciplinary and inter-organizational plans of care where part of the intervention as well. [1]

The case management process fundamentally assists a specific patient/client in coordinating and navigating through their healthcare journey. The key to this assistance is the construction and implementation of a relevant and feasible plan of care that, when followed, will help the patient move towards their stated goals and positive health outcomes with an optimal level of functional capability, wellness, and self-management. Case management will ultimately improve the quality of life for the client.

• Nursing, Allied Health, and Interprofessional Team Interventions

Case management, owing to its focus on coordination, is inherently rooted in multi-disciplinary communication and teamwork. [8] An effective case manager must facilitate communication among various disciplines to develop a plan of care that is inclusive of the many fields that are typically involved in the care of a patient. It is especially important in those patients/clients with chronic conditions or who find themselves in circumstances where they frequently utilize healthcare services. The case manager must interact with a wide range of patients/clients from various backgrounds, have a wide range of capabilities, and access varying family and community support levels.

Nurses and social workers are often seen as ideal for conducting case management due to their clinical experience and communication and teamwork training. [9] [10]  Specific clinical areas may also include other related professionals. They might bring expertise to the case management process such as occupational therapists in the rehabilitation setting, or psychologists in the behavioral health setting. [4] [11]  Clinical experience is uniformly recognized as useful in the training process towards becoming an effective case manager. Most agree that a baccalaureate degree in nursing is an expected minimum with a master's degree preferred and seen as ideal. [10]

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Disclosure: Angelo Giardino declares no relevant financial relationships with ineligible companies.

Disclosure: Orlando De Jesus declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Giardino AP, De Jesus O. Case Management. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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What does a nurse case manager do? The definition and their duties & responsibilities

Home » What does a nurse case manager do? The definition and their duties & responsibilities

A definition of case management in nursing

A nurse case manager is a registered nurse who oversees and coordinates the recovery plan of their patients. They can work in hospitals, medical centres, care homes, the homes of patients and other suitable facilities.

They work with the families, carers and professionals of the patient to ensure they have a secure support system in aid of their recovery. Their biggest role is to create a care plan that helps their patients achieve a healthy recovery with as little discomfort as possible.

Why select a Nurse Case Manager?

Our nursing team are skilled in the clinical assessment of clients’ needs. This is required for clients who are on a ventilator, clients who require artificial feeding (PEG), clients who are at risk of pressure sores, clients who are susceptible to chest infections and much more.

Our nursing case managers have specialist skills in writing risk and care plans, training and managing the support team. In particular looking at the level of competences that support staff demonstrate to ensure our clients are safe and well cared for.

What does a nurse case manager do? The duties, responsibilities and clinical competencies

Nurse case managers use their skills and resources to assess the patients needs, plan suitable rehabilitation, implement the therapy required and offer support every step of the way.

It is their job to ensure a smooth journey to recovery whilst determining potential risks before they happen and planning the best solutions.

The specific duties vary greatly from patient to patient, as every person and injury is different.

General duties of a nurse case manager can be found on our list of clinical competencies that our nursing team are able to sign off on:

• Administration of Medication (Oral, Rectal, Inhaler,Nebuliser,Transdermal)
• Administration of Rescue Medication – Buccal Midazolam, GTN for Autonomic Dysreflexia
• Administration of Medication via PEG
• Oral suctioning
• Tracheal Suctioning
• Tracheostomy Management
• Pulse Oxymetry
• Ventilation (Nasal Mask, Face Mask, Tracheostomy)
• Peg Tube Feeding and Management
• Mechanical Cough Assist
• Assisted Cough
• Administration of Oxygen
• Administration of Medication via Apo Go Pump
• Application of Penile Sheath
• Urinary Catheter Management
• Supra Pubic Catheter Management
• Intermittent Catheterisation
• DRE & Digital Removal of Faeces
• Management of Colostomy
• Management of Mitroffanof
• Management of Urostomy
• Bowel Management with Peristeen Pump

What kind of support is offered by a nurse case manager?

Supporting someone to live back at home following a life changing injury, such as a brain injury, may require that person and their family to have paid support.

AJ Case Management specialise in supporting the client to recruit their own person centred, directly employed care team. This ensures that the client received the highest quality of care, centred on their needs.

A well-trained support team will ensure that the package of care provide runs smoothly. To achieve this training is important from the outset. However often due to the complexity of the clients’ needs it is important that the training is reviewed regularly and that there are regular competency checks undertaken. A registered general nurse will be able to co-ordinate and manage the team’s training and competency reviews.

How is high quality nursing case management maintained at AJ Case Management?

AJ Case Management have a dedicated team of case managers with a variety of professional backgrounds that ensure our team have a broad and specialist skill set.

Our nursing case management team is headed up by Wendy Richardson, Quality Assurance and Service Development Manager. Wendy is an experienced hospital and community Nurse with invaluable expertise working with clients who have complex long-term conditions and their families. She has worked as a Specialist Brain Injury Case Manager with AJ Case Management before taking up her current management role.

Our nursing team also include Lynn Evans, Shelley Lewis and Gemma Sheen, who are all Registered General Nurses with experience in the community and supporting clients with complex needs.

What services do we offer?

AJ Case Management are a specialist case management service who are able to offer Initial Needs Assessments (INA’s) and full Case Management Services. Case Management services include coordination of care and therapy, whilst offering direct support to their client and family.

Contact one of the team to discuss .

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RN CASE MANAGER: University Hospital (Care Management)

The RN Case Manager assesses, develops, implements, coordinates and monitors a comprehensive plan of care for each patient/family in collaboration with the physician, social worker and all members of the interdisciplinary team in the inpatient and emergency department patient care areas.  The position is unique in that it combines clinical/quality considerations with regulatory/financial/utilization review demands.  The position creates a balance between individual clinical needs with the efficient and cost effective utilization of resources while promoting quality outcomes. Organizational Relationships The RN Case Manager reports directly to the Manager of Care Management. The RN Case Manager works closely with the unit-based MPLAN team in reaching unit and organization goals including length of stay, care transitions, readmissions, and other quality initiatives.  In the emergency departments, the RN Case Manager works collaboratively with other members of the interdisciplinary team to develop and implement a comprehensive, integrated discharge plan from the emergency department(ED). The RN Case Manager will recommend and document patient classification of all admissions utilizing established criterion set.

Mission Statement

Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.

Responsibilities*

Characteristic Duties and Responsibilities Care Coordination and Discharge Planning

• Within 24 hours of admission interview each patient/family for anticipated needs post hospitalization
• Develop plan for the day and plan for the stay with providers, patient and nursing staff
• Lead daily care coordination rounds to update the plan and facilitate implementation.
• Initiate discharge plan including early referrals to homecare, DME and infusion services
• Prepare patient/family for discharge
• In collaboration with SW partner follow standard for routine patient/family conference
• Ensure patient handovers to next level of care; work closely with Care Navigators in clinics, complex care Case Managers , homecare and sub-acute liaisons
• Support nursing Model of Care by working closely with nursing managers and staff to achieve Patient Family Centered Care goals: respect and dignity, information sharing, participation and collaboration
• Facilitate increased volume of cases discharged by noon to improve capacity management
• Collect avoidable days information; report findings in care management software, such as Allscripts
• Participate in venues to reduce barriers to discharge

Utilization Review and Utilization Management

• Conduct clinical review on admission; review every 3 days or as requested by payer
• Determine patient classification with provider and ensure all patients placed in observation classification are notified; For inpatient to observation cases, ensure Condition Code 44 billing requirements are met
• Communicates with third party payers to obtain necessary authorization for reimbursement of services.
• Obtain anticipated LOS from provider and ensure patient and multi-disciplinary team is aware
• Refer defined cases for medical secondary review and share findings with providers
• Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials; input into appeals; share findings with providers
• Review all cases with readmission within 30 days; report findings in Care Management software such as Allscript
• Identify opportunities for cost reduction and participate in appropriate utilization management venues
• Conducts referrals and consultation with Physician Advisor

Professional Development

• Actively participates in the performance planning, competency and individual development planning process
• Maintains current knowledge of case management, utilization management, and discharge planning , as specified by federal, state, and private insurance guidelines

Expectations of the position:

• Knowledge of community resources to coordinate safe discharge from the emergency departments
• Excellent interpersonal skills, as demonstrated by the ability to work effectively with individuals and or teams, across disciplines
• Excellent communication and negotiation skills as demonstrated in oral and written forms 
• Ability to work in a collaborative partnership model with Social Workers and other members of the interdisciplinary team, both internal and external
• Organizational and time management skills, as evidence by capacity to prioritize multiple tasks

Nursing Specific Info

Michigan Medicine is one of the largest health care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School in 1850. Michigan medicine is comprised of over 26,000 employees and our vision is to attract, inspire, and develop outstanding people in medicine, sciences, and healthcare to become one of the world's most distinguished academic health systems. In some way, great or small, every person here helps to advance this world-class institution. Work at Michigan Medicine and become a victor for the greater good.

What Benefits can you Look Forward to?

Nursing at Michigan offers a competitive salary with excellent benefits! 

Hourly range for Registered Nurses $38.26-$59.35 / hour

•          Evening Shift Differential-$3.00 / hour
•          Night Shift Differential- $4.00 / hour
•          Day Shift Weekend Differential- $2.90 / hour
•          Evening Shift Weekend Differential- $5.90 / hour
•          Night Shift Weekend Differential- $6.90 / hour
•          Charge Nurse Differential- $1.00 / hour

The benefit package includes: 

• Excellent medical, dental and vision coverage
• 2:1 Match on retirement savings and immediate vesting
• Generous Paid Time Off Allowances
• Robust Tuition and Certification support programs
• Large offering of no cost CEs and professional development for advancement

Required Qualifications*

Required Educational Requirement; applicant must meet one of the following: Bachelors degree in Nursing OR an Associates degree or Diploma in Nursing with a Masters degree in Nursing

Current State of Michigan Board of Nursing licensure

Minimum of three (3) years of acute care RN nursing experience OR 3 years care management of acute care patients.

A minimum of one (1) year of successful experience in at least one of the following classifications:  nursing management ( supervisor or higher) ;  case management; demonstrated advancement in clinical career ladder ( advancement from level C to level D or higher )

NOTE: In order to be considered for this position the applicant must have met or will have met all the required qualifications prior to the start date of employment.

RESUME REQUIRED ( for both internal & external applicants ): 

You must attach a complete and accurate resume to be fully considered for this position.

Desired Qualifications*

• Two (2) years hospital discharge planning experience
• Masters degree in nursing or other health related field
• Case Management Certification such as ACM or CCM
• Excellent analysis and data management and PC skills
• Ability to work in autonomous and self-directed manner
• Experience with InterQual criterion set
• Experience with Allscripts
• Experience with quality improvement initiatives
• Two (2) years home care or skilled home health experience

Work Schedule

Hours: 40 Shift: Day shift, 8am-4:30pm, with weekend and holiday commitments Location: UMH Care Management

Background Screening

Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings.  Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.

Selection Process

Michigan Medicine seeks to recruit and retain a diverse workforce as a reflection of our commitment to serve the diverse people of Michigan and to maintain the excellence of the University. We welcome applications from anyone who would bring additional dimensions to the University’s research, teaching, and clinical mission, including women, members of minority groups, protected veterans, and individuals with disabilities. The Department of Nursing, like the University of Michigan as a whole, is committed to a policy of nondiscrimination and equal opportunity for all persons and will not discriminate against any individual because of race, color, national origin, age, marital status, sex, sexual orientation, gender identity, gender expression, disability, religion, height, weight, or veteran status.   

U-M EEO/AA Statement

The University of Michigan is an equal opportunity/affirmative action employer.

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