What is a Case Management Nurse?

A case management nurse works closely with physicians, nurses and other health care providers to deliver daily care coordination and chronic care management. They also provide coaching, consultation and intervention services to internal clients. They strive to positively influence overall patient health outcomes through focusing on communication, clinical quality and resource coordination.

Basic Job Duties

Case management nurses work closely as part of interdisciplinary care teams. They identify high-risk patients or groups in order to proactively manage their care. They handle referral management, post-discharge planning and the transition to community based care. They provide patient-centered care that uses an interdisciplinary approach to health care coordination. They use evidenced-based standards with expected patient outcomes to establish care goals. Case management nurses cultivate cohesive and team-oriented relationship with colleagues and care partners. Case management nurses screen patients and conduct individualized clinical assessments of health needs and concerns. They create personalized condition-specific action plans that provide appropriate training, monitoring and care management guidelines. Case management nurses regularly evaluate their patients’ progress to meet goals and revise individualized care plans as needed.

Advanced Job Duties

If necessary, case management nurses use remote interactions and technology to maintain active members of care delivery programs. They leverage clinical decision support systems and solutions to monitor patient populations. This means that they are responsible for the identification and stratification of complex risks in co-morbid patients. When appropriate, they perform care assessment transitions for patients who are discharged from hospitals or skilled nursing facilities. Sometimes, they must conduct medication reconciliation meetings with other care providers in order to support safe patient medication management. This usually occurs during the post-discharge planning process or when medication compliance reviews are requested. Case management coordinators advocate and intervene on behalf of their patients and families in order to successfully navigate the health care system and obtain community resources.

Basic Qualifications

Case management nurses usually have a Bachelor of Science degree in nursing or they are a graduate of an accredited master’s degree program. These degree programs will provide a clinical education in patient care competencies. Many programs use simulation labs followed by real-world training scenarios to help students master the required skills. These programs are usually taught by veteran nurses who provide coaching and mentoring to students. Students will take classes in nutrition, pharmacology, organizational systems, safety regulations and medical dosage calculations.
After graduation, they will be technologically proficient nurses who are ready to improve and maintain the health and well-being of individuals and families.

They must be registered nurses and currently licensed by their state’s Board of Nursing, according to the Bureau of Labor Statistics. Most employers require a minimum of three to five years of clinical experience in patient care. Having experience with managed care, interdisciplinary teams and case management is extremely useful. Case management nurses will most likely need to obtain credentials like Basic Life Support or Case Management certification. They need to have a strong professional level of knowledge related to comprehensive clinical assessments in populations with chronic or comorbid diseases. Some employers require them to have a current driver’s license and personal motor vehicle insurance because they may be expected to travel between facilities.

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A case management nurse is an experienced RN who provides specific care to high risk patients with challenging health care needs.