What Is a Case Management Nurse? Your Guide to These Helpful Healthcare Pros
Once you’ve set your aim toward being a nurse, there’s a world of possibilities for where your career could take you. With all the different types of nursing specialties and the niche types of care provided, it can be tough to keep it all straight—and you’re not the only one who might feel this way.
Patients, too, can feel overwhelmed as they enter a whirlwind of healthcare specialists and recommendations. Luckily, there’s a type of nursing focused on helping patients find what they need through the whole healthcare process. This nursing specialty is called case management nursing.
By being a case management nurse, you get to help patients through their journey to health and have a fulfilling career in the healthcare field. But what exactly is case management nursing? And what does the nurse case manager job look like?
What is case management nursing?
Case management nurses work with patients who often have complex medical needs through all the stages of their treatment. Typically, these patients are dealing with long-term chronic illnesses, have geriatric conditions or are recovering from serious injuries. As a patient enters the healthcare system, case management nurses assist patients as they navigate through initial evaluations and determining available options for treatment. Their job is to empower patients with information on what their possibilities are for care.
These nurses also assist the patient with information on costs and insurance coverage, advocating for the patient through the process, especially when it comes to ways to reduce costs. And they can help connect patients with care options and support.
Finally, case management nurses coordinate and oversee the patient’s care to ensure they are getting the attention and assistance they need. Often, their patient care expertise is used to help connect the dots for those on the administrative and payment side. For example, a patient’s individual specialist visit may look extraneous to insurers without the full context of the patient’s case—and that’s not always easy to glean from medical records and billing statements.
As Nancy Mitchell, a registered nurse and contributing writer at Assisted Living Center, says, “Regardless of the circumstances, the most important part of the role is to account for the patient’s emotional and physical well-being and to lobby for their rights when social services are involved.”
Who do case management nurses work with?
Because case management nurses are involved in many stages of patient care and connect patients with resources, they will work alongside a wide variety of other professionals, whether that be doctors, other nurses, rehabilitation specialists, hospital staff or even insurance providers. In addition to working with the patient, they may also work closely with the patient’s caregiver.
For instance, Mitchell says in her role as a case management nurse, she worked with patients’ primary care physicians, other nurses and some specialists. There’s no cookie-cutter formula, though—the overlap with other healthcare professionals depends entirely on the needs of the patient.
Where do case management nurses work?
Given the broad range of care specialists these nursing professionals interact with, it’s understandable if you’re wondering who employs them and where they physically set up shop, so to speak.
In practice, you’ll find case management nurses working in a wide variety of settings. Most nurses in this specialty don’t actually work at a hospital. Instead, many work for insurance companies, for workers’ compensation organizations or in home healthcare.
That being said, many case management nurses still work in hospitals. All this means is that there’s a lot of variety for where you could work as a case management nurse. Whether hospitals are where you want to spend your time, you may have options as a case management nurse.
What makes case management nursing unique?
Aside from the different places case management nurses can work, this job is also unique because of its broad, comprehensive focus. Rather than specializing in a certain subfield in healthcare like cardiology, these nurses care for patients throughout their whole time moving toward wellness. In this way, they also work more closely with a patient over a longer period of time, rather than a position like an ER nurse, who may only see a patient once when they enter the hospital system.
Skills of case management nurses
With all the moving parts in this role, you may be wondering what skills you need to succeed in it. Indeed, because of all the coordination involved in case management nursing, being organized is crucial. And as with any job in the healthcare system, keeping clear records and being able to juggle multiple tasks is imperative.
Communication is also an important skill to have as a case management nurse. “Sometimes, the job also entails dealing with worried family members,” says Mitchell, “So it’s not just medical—you need to be good at communicating with others.”
Having a good bedside manner is another necessary trait for this type of nursing. Because case management nurses work so closely with patients and their families or caregivers who are often stressed or confused with the healthcare system, they need to be able to be kind and considerate in their communications.
The best case management nurses balance this compassion with a strong backbone. As they often advocate for a patient, they need to be able to hold their ground and get the patient the best care.
Patience is another critical trait for case managers. Coordinating care among multiple providers and insurers (each with its own byzantine systems and communication gaps) can be a frustrating experience, particularly for new case managers. The flip side of this, of course, is the satisfaction that comes with helping a patient successfully navigate the red tape and getting them set up with exactly what they need in a timely manner.
Is case management nursing the track for you?
With the focus on patient advocacy and involvement in all stages of the healthcare process, case management nursing is unique among the different nursing specialties. Waking up each day and helping patients get the best care possible and navigate the healthcare system can be an incredibly rewarding career and area of nursing.
Even with its unique place in the nursing world, case management nursing shares the standard nursing requirement of being a registered nurse (RN).
Luckily, if you’re ready for a fulfilling career as a case management nurse, there are options to quickly gain this important credential. Read our article “How to Become an RN Fast: 3 Potential Paths to Pursue” to take the next steps toward a job in case management nursing.