Careers in Healthcare: Case Management: More than meets the eye

By: Betty Nelson, PhD, RN

Case management is a collaborative process of coordinating complex, unrelated patient care services to meet the needs of the patient while controlling the costs of services.

Why is case management important?

While case management has been practiced since the late 1800’s in the United States, it has risen in prominence just over the last decade. Case management emerged as a response to the need to maximize outcomes of the competing demands of patient care, availability of services and healthcare financing.

Many conditions pose significant challenges to providing the right care, especially when they occur simultaneously:

  • Physical limitations
  • Financial issues
  • Advances in medical science and biotechnology
  • The rise of more complex and severe illnesses
  • A complicated health insurance environment.

What is the role of a Nurse Case Manager?

According to the American Case Management Association, a case manager’s responsibilities include:

  • Advocacy & Education – ensuring the patient has an advocate for needed services and any needed education.
  • Clinical Care Coordination/Facilitation – coordinating multiple aspects of care to ensure the patient progresses.
  • Continuity/Transition Management – transitioning of the patient to the appropriate level of care needed.
  • Utilization/Financial Management – managing resource utilization and reimbursement for services.
  • Performance and Outcomes Management – monitoring, and if needed, intervening to achieve desired goals and outcomes for both the patient and the hospital.
  • Psychosocial Management – assessing and addressing psychosocial needs, including individual, familial, environmental, etc.
  • Research & Practice Development – Identifying practice improvements and using evidence based data to influence needed practice changes.

How can you become a case manager?

A case manager position requires experience in a hospital, and the post is usually filled by a nurse or social worker. Many of the basic skills can be learned on the job, although continuing education is available. Plus, the movement toward degree programs in this specialty, such as an MSN with a specialization in case management, is gaining momentum.

Certification is also becoming a desirable standard. The American Case Management Association, the Case Management Society of American, and the American Nurses Credentialing Center offer certifications for case managers.

What are the career prospects for a Case Manager?

Case managers are employed by hospitals, HMOs, health insurers, employers, or they can be self-employed. With our country’s aging population and pending changes in healthcare, the prospects for a career in case management are excellent. There is an ever-growing need and demand for case managers.

About American Sentinel University

American Sentinel University delivers the competitive advantages of accredited online degree programs focused on the needs of high-growth sectors. Its Bachelor’s and Master’s nursing degree programs are accredited by the Commission for Collegiate Nursing Education (CCNE). The university is accredited by the Distance Education and Training Council (DETC). The Accrediting Commission of DETC is listed by the U.S. Department of Education as a nationally recognized accrediting agency and is a recognized member of the Council for Higher Education Accreditation.

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