Chat Transcript: Case Management–Where are the Opportunities for Nurses?

What type of background and nursing education does someone need to be a nurse case manager? And where are the jobs in this exciting and expanding area of health care?

Recently, American Sentinel University and NurseTogether.com sponsored a live chat, to discuss nursing opportunities within the field of informatics. Here’s a transcript this lively Q&A.

American Sentinel: Traditionally, case management has been a tool reserved for complex cases, usually hospitalized patients needing multi-disciplinary interventions. However, that scenario may change as accountable care organizations (ACOs) take center stage this year, but we are still waiting on the final regulations and guidelines.

One of the major revisions to come with healthcare reform efforts are mandated goals for cost containment and improved outcomes. Hospitals must demonstrate efforts to coordinate care among physicians, primary care, rehabilitation, home care, and other providers. Thus, health providers will be accountable for care across the continuum and will be paid accordingly. This has led many hospitals to purchase physician practices.

NT.com member: It seems like Case Management has come out of the background and into the forefront of nursing.

NT.com member: What is the catalyst for all this?

American Sentinel: With their mandated goals of cost containment and improved outcomes, ACOs will likely find they need case managers to strategically manage services for all patients, even those in ambulatory care. It’s been said that case management, with its current emphasis on complicated cases, needs to evolve into care management, with a focus on wellness, prevention, and efficient care for entire populations of patients both inside and outside the hospital. Tomorrow’s case managers will have to consider clinical, financial, and patient advocacy functions simultaneously, as they balance competing interests.

The recent Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health eloquently details the need for nurses to improve their academic and certification credentials. To respond to [the] demands of an evolving healthcare system and meet the changing needs of patients, nurses must achieve higher levels of education and training. One step in realizing this goal is for a greater number of nurses to enter the workforce with a baccalaureate degree or to progress to this degree early in their career. Moreover, to alleviate shortages of nurse faculty, primary care providers and researchers, a cadre of qualified nurses needs to be ready to advance to the master and doctoral levels.

It also comes as no surprise that the Bureau of Labor Statistics in its 2010 Occupational Outlook Handbook identifies case management as a field projected to grow faster than other job categories. For nurses looking to be more competitive within the evolving marketplace of professional nursing practice, case management can be an excellent career choice. This marketability in the case management field will depend upon obtaining the credentials, education, and on-the-job experience that tomorrow’s employers will be seeking, so it’s crucial to identify the knowledge and skills you will need and began planning strategically to achieve them.

American Sentinel: Aetna has identified that last year health care providers started restructuring the way they deliver care, in order to maximize reimbursement. Although Aetna actually was ahead of the mandatory requirements, four years ago their upper management started to evolve their processes with their insured, and especially with physicians.

American Sentinel: Can you explain who or what are considered  “Accountable Care Organizations”?

NT.com member: An accountable care organization (ACO) is a type of payment and delivery reform model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients.

NT.com member: If someone is currently working in a case management role and is certified, what is the benefit of getting their Masters? I can see need for better educated nurses, but I am master’s prepared and still can’t get a job as a case manager because I don’t have requisite experience. What is the best “quick education” to obtain to improve my chances as another masters is not feasible financially or time-wise at my age?

American Sentinel: Accountable care centers will have a payment rate that is similar to DRGs, so the one payment must be spread among multiple providers.

NT.com member: How about someone like myself with a BS in Health Science for over 20 years now? I am also an LPN. Do I need a BSN in order to be marketable?

American Sentinel: Case Managers are on the leading edge of the new health care scene. They are the ones that will broader preventive care to communities, collaborate with outside vendors and other health care professionals, and help to restructure health care treatment and payment.

There is no question that case management is being promoted by Medicare and will become even more important with Medicare mandating Accountable Care Organizations. This is not the only thing and this is not the only reason for case managers. Case Managers will emphasize and focus efforts on bettering the health of communities, and integrate the patients’ care into many different areas that could increase the patients quality of care and quality of life.

NT.com member: As a former LPN and now a RN I understand that in order to survive in the industry, you will need an elevated degree. BSN is where to start and then who knows where you can go from there. In the IOM report on the future of nursing, it is spelled out that more nurses need to enter the workforce with a Baccalaureate degree

American Sentinel: Have you taken the certification examination yet? Credentials are usually pretty marketable. Online nursing degrees such as American Sentinel’s MSN with a case management specialization can make you attractive to employers, provide you with case management knowledge and skills, and give you the academic background you’ll need to pass the credentialing exam.

I encourage you to consult the Case Management Society of America at cmsa.org. This organization has chapters in many cities across the US and offers a good way to connect on a local level and interact with those in the field. Also go to CareerBuilders.com and search Case Management Jobs to see what skills employers are looking for in a case manager.

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