Nurses and Case Management

Nurses and Case Management

Healthcare Case management is an important field for any administration or hospital.  It helps track the overall health and needs of patients.   It is critical to the success of the hospital as well as to the patients.

Nurses are excellent candidates for healthcare case management. Please review our Nursing Case Management Program

Nurses are excellent candidates to become case managers for hospitals.  Nurses who have worked at the hospital have a knowledge of the system and can prove to good internal hires by the administration.   Nurses with skills in case management can make the switch from the floor to the office very easily.  Some positions require some type of formal education to enter into this field.  A certification is an excellent way to achieve the education and the confidence needed to fill a position of case management.  Most hospitals prefer to have a case manager who is certified.  Many hospitals also pay for their nurses or case managers to become certified.

The American Academy of Case Management offers a Healthcare Case Management Certification.  This Nursing Case Management focus is an excellent way for nurses to become certified and be able to perform their functions as a case manager.  The Nursing Case Management program is independent study and online.  After the completion of five core courses, the nurse or student can apply for a four year certification.

Again the courses are independent study and self paced.   The courses are completely online.  Each course requires a text book and the completion of an open book exam.  Students can utilize their instructors as much or as little as they need.

Nursing Case Management is critical to hospital success and patient well being. Please also review our Nursing Case Management Program

Since Case management such a critical and important aspect to hospital function and patient well being, nurses can become excellent candidates to become case managers.  Please review AIHCP’s Nursing Case Management program and see if it matches your academic and professional needs.  With the education and training from the American Academy of Case Management, you will be able to face any case management challenges in a hospital setting.


What Do Nurse Case Managers Do?

Nurse Case Managers or Healthcare Case Managers are important parts of the hospital system.  A case manager coordinates with various departments regarding the overall health of the patient.  The case manager is the record keeper and makes sure all medical professionals are on the same page.   They also play a key role in helping recover.  In this way, it goes well beyond just the background of the patient and the initial stay but also includes recovery plans.

Nurse Patient Educators can play an important role with the Case Manager in ensuring the recovery and overall health of the patient.  This reduces re-entry to the hospital and cuts down price.  In this way, nurse case managers play a big role in outcome base statistics.

Nursing Case Managers are important for records, coordination and recovery care. Please review our Nursing Case Management Program

If you find interest in the case management field, please again review the American Academy of Case Managements information and see if it meets your professional goals and needs.

Nursing Case Management: A Focus on Advocacy

Nursing Case Management

Nursing case management is becoming more important in overall health care delivery. A nurse case manager must wear many hats and juggle many tasks at once in order to be successful at his or her job. Perhaps one of the most important aspects of being a case manager, however, is acting as a patient advocate. This is such an ingrained part of being a case manager that many nurses act as an advocate without even realizing it by doing things like noticing a prescription medication error. There are many other aspects to the role of the nurse case manager as patient advocate, however. Below we’ll highlight some of them, with an emphasis on how nurses advocate for their patients to receive care and social support.

What is advocating?

There are many different definitions of patient advocating. They may depend on a nurse’s personal philosophy or the setting in which he or she works. In general, advocating means standing up for your patient and your patient’s rights. To advocate properly, a nurse case manager must set his or her personal preferences aside and realize that excellent health care is focused on the patient’s needs instead of the needs of her caregivers.
Advocating may involve speaking up in order to get the best care for your patient, but it also may simply involve being an understanding and accepting caregiver. For example, many patients have personal or religious qualms about giving or receiving blood. Being a patient advocate involves not judging these patients or condemning them for not making the medically “appropriate” choice. Advocacy involves supporting their choice while at the same time educating them about their options.

Advocacy isn’t always comfortable

There are times when advocating can put a nurse at odds with his or her employers. The number of nurses, however, who ignore these difficulties in order to provide their patients with optimum care is staggering. For example, at a hospital in Texas, two nurses came forward to identify a physician who they felt was negligent with patients. They believed this physician put some patients at risk and they told the administrator at their hospital. When the administrator failed to act, they went to the Texas Medical Board with their complaints. They were fired and then charged for misusing official information. Eventually the charges were dropped against one of the nurses and the other was quickly acquitted. Their defenses were paid for by donations raised by the Texas Nurses Association.
Although these two nurses went through an extremely difficult ordeal, they did it because of their drive to act as a patient advocate. This is perhaps the ideal example of working for your patient’s rights as these two ignored potential threats to their own careers in order to get the best care for their patients.

The benefits of advocacy

A nurse may benefit from advocacy as it makes him or her feel better about the job they are doing. Most who enter healthcare professions do so because they are concerned about their fellow human beings. Advocacy truly allows for the expression of that motivation.
The true benefits of the nurse case manager as patient advocate appear as benefits to the patient, however. Nurses are the main system of support for patients, and are responsible for easing their transition through the different levels of treatment in a hospital (such as emergency, surgery, etc.). They are also the ones who provide patients with emotional support and often do the same for the families of those patients. Without the support offered by nurses, many patients would have a frightening, confusing, and overwhelming medical experience.
Many healthcare facilities are beginning to recognize the importance of the patient advocacy. They have begun instituting ways to protect nurse’s from repercussions if they are simply advocating for their patients. There have even been some nurses who have taken their skill for advocating and turned it into a full-time career. Private and public groups, whose primary duty is advocacy, have sprouted up in recent years. These groups help patients navigate through the daunting decisions inherent in a healthcare process.
Advocacy is an often overlooked, but critically important part of nursing. Without it many patients would be lost to navigate a complex healthcare system on their own. Patient advocacy is one of the more selfless acts we see in healthcare, and it’s part of what makes the nursing profession special. To learn more about nursing case management, click here.

Nursing Case Management is an Exciting Field!

A nurse checking a clipboard
A nursing case management professional hard at work!
In the field of nursing case management is a skill set that continues to become more and more important. With the current state of health care, the ancillary issues – those that do not relate directly to treatment – have been multiplying, and sorting through them without professional assistance has become more of a challenge. Learning about and becoming certified in the field of case management allows nurses to offer that professional assistance to their patients. A nurse who is also a competent case manager can help resolve treatment conflicts, coordinate treatment provided by different specialists, sort out the serious financial ramifications of health care, and, generally speaking, minimize the bureaucratic hassles a patient experiences. The value of this skill to patients makes it a valuable skill to health care providers, too. A nurse that takes the time to cultivate case management skills will find that his or her value to employers will rise significantly.
By Eric Moore

Nursing Case Management Field is Growing!

Opportunities in Nursing Case Management

As a nurse, one should consider the field of case management
As a nurse, one should consider the field of case management

More and more people are living longer, and as they do they encounter additional health challenges. This means there is a much greater demand for trained health care professionals now than there ever was before. The real need is for skilled nurses who can manage individual cases, working with doctors and technicians to enable better outcomes. Nursing case management is a growing field, requiring dedicated, caring nurses who can see the whole person, not just a set of symptoms, and lead the patient down the path to wellness. This profession needs people who are tender yet tough minded, able to make the decisions necessary to ensure that doctor’s orders are followed correctly, and to lay out treatment plans that can be followed with confidence. If you think you have what it takes, this is a career option you should explore, allowing you to really provide high level care and help to all.
If you are a nurse looking to enter the nurse case management field then you need a good education.   Many case management programs are available online and allow studying at your own pace.

Nursing Case Management and the Utilization Review Role

The Many Duties Under Case Management

Care management
Care management is about managing resources and time
Case management is the process of matching the resources available to the needs of the individual patient in such a manner to enhance the quality of patient management and patient satisfaction. Nursing Case Management  has held a relatively low-profile position in the field of health care till the latter half of the 20th century. The cost effectiveness and continuity of patient care is increased through utilization review and discharge planning. Case management nurses form an important part of the healthcare team.
Nursing Case Management ensures that a patient receives the most effective health services by being in touch and communicating with the patient, the doctor, the health care providers, and the other allied health care services such as insurance. The duties of a case management nurse include the following: They act as care coordinators between the doctors, therapists, dieticians, specialists, etc., and develop an effective working relationship. They record the symptoms, perform the diagnostic tests, and collect all details about the vital signs of the patient. Promote the efficient and effective utilization of clinical resources. They constantly communicate with the doctors and insurance companies. Ensures adequate care for the patient during the hospital stay and facilitates timely discharge. Conducts review for appropriate utilization of resources and services from the instance of admission of the patient through discharge. Makes sure that the patient does not get more than necessary care. Facilitates a relationship between the family and the patient to enable them to take informed decisions.
Case management nurses are RN’s who have undergone specialized training or have completed certificate programs in case management. On completion of the program the certificate is issued if the candidate has a current valid RN license, has an experience of two years as a full-time RN, and has worked for 2000 hours as a case management nurse in the last three years. Though the additional training is not always compulsory, jobs in specialized health care settings do require the specialty training.
Skills required to be a successful case management nurse include all skills required of a medical job, communication skills, the ability to respond quickly to medical emergencies. The case management nurse is expected to gain knowledge about diagnosis related group codes (DRGs), develop critical thinking, be observant and keen and improve the ability to analyze. Certified case managers are always paid a higher salary than other nursing professionals. A case management nurse earns an average salary between $55000 and $75000.
The average salary of a Case Manager Nurse is $55,000 to $75,000
The average salary of a Case Manager Nurse is $55,000 to $75,000
The job of a case management nurse is much in demand as hospital stays of patients are becoming much shorter. Role of a Utilization Review Nurse A utilization review nurse reviews individual medical cases to ensure that they are getting the most effective care. Such utilization review nurses work for the hospitals and sometimes for insurance companies in an advisory capacity and decide whether specific care for the patient is to be approved or not. They balance the needs of the patient to make the entire episode of care to be one that is cost effective, enforce policies and are instrumental in providing care that is suited to the needs of the individual patient. Working as a utilization nurse may involve situations when the cost issues have to be weighed against the obligation of providing care to the patient. They may have to approve or deny a specific method of treatment, a diagnostic test or a medication to the patient as per organizational guidelines. Utilization review nurses review requests pertaining to hospitalization of patients, medical imaging tests, recommended medical procedures and also whether the cases meet the standards for reimbursement of claims by the insurance companies. They ensure that patient care stays at specific levels and make adjustments in case of changes that may occur.
A utilization review nurse must be a qualified RN, at the baccalaureate level, and must have some minimum experience in the field of case management nursing. The skills associated with this job includes the ability to work under stress, be able to work independently without supervision, keen observation and attention to detail, be able to work with large amounts of data, ability to analyze and decisiveness. Utilization review nurses earn an average salary of $75000 per annum, a pay that is higher than what most RN’s earn.
If you are interested in Case Management Certification, please review the program.