A Career in Case Management: Staying Relevant in the Nursing Profession
The following is an excerpt of the NurseTogether.com Community members’ online chat (March 8, 2011) with Dr. Catherine Garner, dean of health sciences and nursing at American Sentinel University.
Dr. Garner: 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.”
NT.com: Where do you think the Case Management Degree will fit in with the Affordable Care Act?
Dr. Garner: 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 take center stage next year. 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.
With their mandated goals of cost containment and improved outcomes, ACO’s 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.
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.
NT.com: Can case management coordinate with a medical home?
Dr. Garner: Absolutely. Someone will need to manage the patient and his or her family – a nurse.
NT.com: Many of us who do Life Care Planning are already doing that. What does this degree do for us?
Dr. Garner: Life Care Planning is a part of the curriculum, and you can challenge this if you have experience.
NT.com: How long is this course?
Dr. Garner: American Sentinel’s MSN in Case Management is 36 credits or 12 courses. If you are already CMSA Certified, you are eligible for 9 credit hours towards your Master’s in Case Management - leaving just nine classes to achieve your MSN at American Sentinel University. Visit americansentinel.edu for more information.
NT.com: How do you see the role of a clinical nurse leader in comparison to the case manager?
Dr. Garner: I think the CNL will continue to be hospital-based, whereas the huge growth for the case manager is based in ambulatory care settings, primary care, and alternative organizational settings. Organizations like Kindred Health (222 facilities) are positioning themselves as ACO’s and are aggressively hiring nurse case managers.
NT.com: What is CMSA?
Dr. Garner: CMSA is the Case Management Society of America. For more information, visit cmsa.org.
NT.com: What are the duties of a case manager and what qualifications are required for this position?
Dr. Garner: 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.
It’s not only hospitals and group practices that will be employing case managers, but insurers as well. In a pilot program, Aetna pioneered the practice of embedding case managers into large physician practices that had at least 1500 patients enrolled in Aetna’s Medicare Advantage plan. The case managers worked side by side with clinical staff, helping to manage patients with multiple conditions and coaching patients with chronic diseases such as diabetes. The face-to-face interaction enhanced their ability to collaborate and develop trust with medical staff. Results were positive, and Aetna was able to control costs by avoiding unnecessary hospitalizations and complications related to chronic disease.
NT.com: Will having a master’s degree be the norm in the coming years?
Dr. Garner: More and more companies are requiring the MSN because of nurses’ many duties and responsibilities.
NT.com member comments: I work in long term care. I think our case managers are all about the care plan working towards Medicare reimbursement.
Dr. Garner: There is no question that case management is being promoted by Medicare and will become even more important with Medicare mandating Accountable Care Organizations.
NT.com: Where is American Sentinel University located?
Dr. Garner: American Sentinel is an online university based in Colorado.
NT.com: What do you see as the difference between a case manager and a care manager, or is there any?
Dr. Garner: Case manager and care manager are titles used separately, but they often mean the same thing. It’s just that the semantics of “case” are very impersonal and what nurses do is more care-related, which involves a more holistic approach.
Kindred Health: Hi, this is Wendy DeVreugd, Sr. Director of Case Management, joining from Kindred Healthcare West Region.
Dr. Garner: Welcome, Wendy. There is some interest in employment here today. Why do you encourage the Master’s Degree in Case Management?
Kindred Health: I encourage professional growth because we need not only the advanced nursing skills, but also the management skills to work and grow with each other.
NT.com: Does one need to get a BSN before going straight into the MSN program?
Dr. Garner: In our RN to MSN, you take six bridge courses in the BSN and then go directly into the master’s program, which is 12 courses. You do not earn the BSN but if you know you want the MSN, this program is more cost effective.
NT.com: What does the case management field entail?
Dr. Garner: Case management uses everything we know and do as nurses. You need to understand the pathophysiology, disease management, coordination of care among various providers, and patient and family education – and you are very independent!
The field of case management is also seeing a new emphasis on professionalism. A study by the Commission for Case Manager Certification (CCMC) reports that more employers are requiring case managers to be certified, and more employers are offering additional compensation for certification. Often, it’s expected that a newly hired nursing case manager will become certified within three years of starting the job.
In addition to being more visible within the organization, case managers are likely to become more accountable. In order to really deliver, they must know their employer’s specific clinical and financial goals and plan strategically to help the organization reach those goals, whether it’s increasing preventive screenings like colonoscopies or bringing down rates of avoidable readmissions. As they become the central coordinator of multiple activities, case managers will have to be ready to assume authority.
Settings can vary. Case managers may work for an insurance company monitoring a case load of at-risk pregnant mothers, do phone calls, arrange home visits and home fetal monitoring, or encourage visits to the physician.
A case manager can work for a hospital in more of a discharge planning role or arrange physician follow-up visits, medical equipment, etc.
In a rapidly shifting landscape, nurse case managers will need to keep up with new care models like ACO’s and should even take a leadership role in their development. In addition to clinical skills and case management concepts, they will have to be knowledgeable about reimbursement models like capitation and pay-for-performance, as well as other financial matters.
NT.com: What is the starting pay for a new case manager?
Kindred Health: Pay differs according to the geographic region and wage index. San Francisco is at 168% of the national average, and the state of California is at about 112%. In California, where I am located, case managers start at about $75,000.
NT.com: Is it true that these positions will not be hospital-based?
Dr. Garner: With the new accountable care organizations, these positions are more likely to be in the community. Also, insurance companies are increasingly hiring case managers to manage those with chronic conditions.
NT.com: What impact will accountable care have on insurance companies, Medicare, and Medicaid?
Dr. Garner: Accountable care centers around a “case rate” payment similar to DRG’s, so the one payment must be spread among multiple providers.
NT.com member comments: Does anyone know of any training or educational program to become a case manager?
Dr. Garner: American Sentinel offers an online MSN Case Management Degree – 36 credits or 12 courses.
Also note that the range of case management means that those with acute care and critical care backgrounds are needed as well as perinatal and pediatrics. Much of the case load will be geriatrics in the future, as we all age.
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.
NT.com member comments: I am in the DNP program at American Sentinel University. I have been in several online programs and I have to tell you that I love it! The program is very user-friendly for the working nurse.
Dr. Garner: Thank you! For those looking for a doctoral program, American Sentinel offers a Doctor of Nursing Practice in Executive Leadership, a two-year online degree open to nurses with a MSN or another master’s degree.
NT.com: Are there any grants available to help pay for education?
Dr. Garner: We have federal financial aid. Also look to employers who provide tuition reimbursement. If you are already CMSA certified you are eligible for 9 credit hours towards your Master’s in Case Management – leaving just nine classes to achieve your MSN at American Sentinel University. See americansentinel.edu for more details.
NT.com member comments: Can nurses use job experience for course credit?
Dr. Garner: Yes. We have a process where you submit work experience for credit. Your advisor can walk you through this process.
NT.com: Are all case managers also nurses?
Kindred Health: Case managers can be many people – one with a bachelor’s degree in a health-related field or licensed to do independent patient assessment (RN, social worker).
NT.com: So do you foresee the replacement of current social workers and case managers who are not nurses?
Dr. Garner: Social workers will always have a place, but I think that the complexity of care with disease management is going to place nurses at the center of this movement.
NT.com: How can we access your article on accountable care?
Dr. Garner: If you go to americansentinel.edu, there is a white paper on our blog giving more details on Accountable Care Organizations.
Kindred Health: I would also like to note that Kindred Health is supporting growth of new nurses in case management. We offer internships at some sites and a mentoring program.
NT.com: What about opportunities to work from home?
Dr. Garner: Many disease management companies hire nurses to work from home, as do insurance companies. Check out CareerBuilders.com.
To summarize, if you have your associate’s degree in nursing, congratulations! But it is not enough anymore since you will continue competing for positions with nurses who have higher education credentials. You will also be limited in the future if you aspire to management or specialty positions. If you do not have your BSN, now is the time to start your journey. American Sentinel is here to help. In addition, if you aspire to case management, nursing education, infection prevention and control, leadership, and health informatics, you are going to need a master’s degree. Let’s face it; if you want to work alongside physicians with years of graduate education and pharmacists with doctoral degrees, you need to have the educational credentials to present yourself as an equal on the team.
