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Case Management Nursing Certification

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case management nursing

With health care spending expected to rise to $4 TRILLION by 2015 [1], it`s no wonder the healthcare process can seem confusing, disjointed and all too rushed in many cases. Healthcare providers and insurance benefits administrators are faced with meeting the needs of a rapidly aging population with increased acuity levels, diverse physical, emotional, and socioeconomic needs, while also containing costs. When a patient`s care involves numerous specialists in addition to the primary care provider, duplicate procedures, gaps in treatment, and inappropriate care is harmful to patient well being, the healthcare system, and the benefits provider. Someone needs to assess the "big picture" in order to put the pieces of this puzzle into some sort of sensible order!

Case Management Nurses can provide cohesion to the healthcare process and help patient`s achieve optimal wellness through advocacy, education, communication, and facilitation of resources and services.

If Healthcare Was An Orchestra, the Case Management Nurse Would Be the Conductor

Case/Care managers believe patients need an advocate...someone who helps clients understand what`s wrong with them, what they need to do about it and why those treatments are important. In this way, case and care managers serve as catalysts. By participating in the equation, case and care managers enable their clients to achieve goals more effectively and efficiently.[2]

Case Management Nurses communicate directly with the patient, providers, and insurance benefits manager in order to facilitate optimal outcomes for all concerned. Case Managers are proactive in getting appropriate, high quality care and treatments for patients in order to help achieve desired outcomes without exceeding benefits coverage. Case Managers employ the nursing process in order to assess the needs of patients and their support systems, develop plan of care, set goals, facilitate implementation, evaluate progress, and adjust as necessary throughout the duration of hospitalization, illness, disability, or need for service.

Clinical Case Managers often specialize in a particular disease or patient population such as cancer, cardiac, geriatrics, pediatrics, addiction, or rehabilitation. Whatever they specialize in, and wherever they work, the primary goal of case management is to maximize patient well being while minimilizing hospitalization and costs. Without Nurse Case Managers bureaucratic red tape and inappropriate treatment can delay patient recovery. Everyone benefits when case managers` objectives are met.

Improve Patient Well Being and Health Care Outcomes

Case Managers blend the knowledge of nursing, social work, and utilization review together when assessing a patient`s physical, emotional, social and economic situation in order to develop a comprehensive plan to help meet the complex and varied needs of each patient. They work to educate patients on disease process and medications, promote preventative health, and help patients make informed decisions.

Acting as a liaison between the patient, providers, and insurance company, case managers help achieve more positive outcomes for patient`s health care needs by facilitating access to the right providers, appropriate treatments, and ensuring that available resources are used in a timely and cost effective manner. Case Management Nurses help patients get healthier faster and hold costs down.

[1] National Coalition on Health Care, “Health Insurance Costs,” http://www.nchc.org/facts/cost.shtml (Report of February 2008).

[2] Case Management Society of America (CMSA).

Earn a Case Management Nursing Certification -Online

Certification demonstrates that the case manager possesses the education, skills and experience required to render appropriate services based on sound principles of practice. Certificate programs are designed for health and human services professionals, including registered nurses, social workers, occupational therapists, physical therapists, rehabilitation counselors, psychologists, and medical doctors. Courses may include:

  • Introduction to Case Management
  • Case Management Process
  • Case Management Tools
  • Quality Measures
  • Disease and Disability Management
  • Case Management for Pediatric and Geriatric Populations
  • Legal and Ethical Issues in Case Management
  • Designing Case Management Models

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