What is a Case Management Nurse?

A case management nurse functions as a key part of patient care. This position involves advocating patient welfare, acting as a social worker and serving as a go-between for patients, their families and healthcare providers. Responsible for organizing patients’ cases from admittance to discharge, case management nurses understand the importance of making cost-effective decisions and hospital processes. These positions require licensure as a registered nurse (RN), and optional certification or additional education in a case management field may increase employment opportunities and lead to higher salaries.

What is a Case Management Nurse?

A case management nurse works with healthcare providers and hospital staff to coordinate care for patients, especially in long-term cases such as cancer treatments, according to Discover Nursing. These nurses are crucial for the evaluation of healthcare treatments, the assessment of resources and the negotiation of cost-effective treatment methods. Adhering to legal and ethical standards, case managers are responsible for making decisions that directly affect the care a patient receives. To improve the process of utilization review and familiarity with the case decisions, case management nurses may specialize in a specific medical discipline such as geriatrics or oncology.

A combination of healthcare and social work, case management nursing requires the ability to assess all of the patient’s possibilities and strong organizational skills. Trained nurses typically compile and report on data as well as collaborate with a team of resource managers to make large-scale decisions. Case management nurses act as intermediaries between healthcare institutions, physicians and their patients. Common duties include developing proper treatment plans, providing referral services when needed, obtaining and submitting accurate healthcare information and providing patients and their families with advocacy support.

Case management nursing programs generally require students to complete a nursing program and earn a registered nurse (RN) designation prior to enrollment. Building on the RN experience, postgraduate certificate and master’s programs train nurses to implement supervisory and case management duties for overall patient care. Some schools may offer working nurses the flexibility of online, weekend or evening courses. Several professional organizations may provide certifications for aspiring case management nurses, testing students on legal requirements for the profession, the development of treatment plans and interviewing techniques. Continuing education courses are generally required to maintain certification.

Case managers may also work throughout the community, in rehabilitation facilities or in the insurance industry, according to Forbes. Case managers can provide either short- or long-term assistance to patients and their families, and those working in a hospital setting may also help individuals from assisted living facilities and nursing homes, accident victims and hospice patients. Case managers also facilitate care of patients with substance abuse or mental health issues, and case management nurses provide support services to victims of neglect and abuse.

Related Resource: What is a Health Policy Nurse?

Case management nurses are involved in coordinating patient care, particularly when patients may be hospitalized for extended periods of time. They serve as an intermediary between the patient and his or her healthcare providers, and they may also act as advocates for patients by developing treatment plans or referral services when needed. As such, a case management nurse must not only understand hospital policy and each patient’s individual situation, but he or she must also know how to act as a liaison between all parties to develop an appropriate treatment plan and ensure the best outcome possible for the patient.