Work From Home: Nurse Case Manager
Becoming a case manager is quite a bit different than bedside clinical nursing. With these differences, comes new opportunities. If you are curious about case management, this article is for you!
Many nurses have the dream of working from home. But, how?
There are several different types of work at home nurse positions. One of the most common work from home nursing positions is a nurse case manager. Case managers work for insurance companies, hospitals, home care, hospice and managed care organizations to name a few.
Some nurse case manager positions are a combination of work from home and onsite duties. While others are 100% work from home, telephonic positions. Each individual type of case manager will have specific job duties based on the industry and type of patient or client.
There are specific tasks or duties that all case management positions will complete:
Case managers have a caseload of clients to manage. Average caseload size varies depending on the industry and acuity of patients.
Managing a caseload of clients includes managing the flux of admissions, discharges and changes in care that requires revisions to the case management plan. You will likely have an average daily production or number of visits or calls you will need make each day. At first, managing a large number of cases over months or even years may seem overwhelming. Over time, you will become more comfortable with the art of caseload management.
All nurses who provide care or services to patients conduct assessments. Working in a telephonic environment is certainly no different. Conducting assessments over the phone can be challenging. You have only one sense to rely upon, your hearing. You must become very attuned not only to what the patient or client says, but how they say it.
Just as nurses in hands-on care positions, you will collect a health history, medication assessment and create a list of current problems. With each assessment, the case manager uses critical thinking and clinical skills to ensure the patient receives the education needed to make sound health decisions.
All case managers assist their patients with coordination of care or services. You will be assessing the patient's primary care needs, education needs and the need for other support services. You will become familiar with providers within the client's service area. If you would for an insurer, you will likely need to have working knowledge of their policies and products so that you can easily coordinate covered and noncovered services.
Nurses advocate for their patients.The role of the case manager can oftentimes come with a few tricks in the department of advocacy. For example, if you feel that a patient needs to have an MRI of their shoulder, but the insurance company does not cover this test, how should you proceed when you work for the insurance company? Do you advocate for the patient and attempt to get the test approved? Do you advocate for your employer and simply accept that the test is not covered?
This can be a tough situation for case managers to navigate. A general rule of thumb is to always advocate on the behalf of the patient. Even if services are not readily available, there will be a way to get the patient the care they need. You may have to reevaluate the situation and brainstorm for another answer.
Create and Update a Case Management Plan
The Case Management Plan is a tool. This tool helps you to collaborate with the patient to create goals they want and need to accomplish. The means by which the goals are achieved are interventions. The interventions will likely be items that both you, as the case manager and the patient will need to complete in order to meet the goals.
As the patient achieves goals, you will create new goals. Most case management plans will have specific types of goals required base on the industry or specialty of the patients' needs. For example, if you work with injured workers, you will always create a goal specific to their plan to return to work. If you work with diabetics, you will likely have a goal that is specific to their medication management and daily glucose monitoring.
Case Managers may not provide direct hands-on care, however, they are performing nursing tasks. They use their nursing knowledge to assess the patient's needs and create a plan. They work one on one for longer periods of time with their clients to achieve better overall health outcomes.
If you think that case management may be for you, research the role of case managers. Below is a list of resources to learn more:
Case Management Society of America: CMSA Home - Case Management Society of America
American Case Management Association: ACMA : American Case Management Association
Commission for Case Management Certification: Commission for Case Manager Certification (CCMC)
About melissa.mills1117, BSN
Melissa Mills is a nurse who is on a journey of exploration and entrepreneurship. She is a healthcare writer who specializes in case management and leadership. When she is not in front of a computer, Melissa is busy with her husband, 3 kids, 2 dogs and a fat cat named Little Dude.
melissa.mills1117 has '19' year(s) of experience. Joined Feb '17; Posts: 67; Likes: 131.Dec 16, '17I've been training for a case management position for the past 5 weeks. I'll start working from home next month and I'm so excited!!Dec 16, '17I have to say that i have applied multiple times to multiple work at home job postings for an experienced case manager. I have yet to even receive a call for an interview. I have only received auto reply emails thanking me for my interest in the position. I have an MSN, CCM and experience as a case manager, so I am not sure why I seem to be having difficulty! My point being that it is not as easy as it seems....at least that has been my experience!Dec 16, '17Maybe they feel that you're OVER qualified. That's not a bad thing to me, however, some employers want someone they can teach. Have you heard the saying "You can't teach an old dog new tricks?"
You'd think that they'd appreciate a fully experienced nurse, but alas... it is what it is. I hope you find the job you want.Dec 16, '17Thanks for the article. I'm a new graduate registered nurse and have realized that bed-side nursing isn't really for me. Do you have any tips as to how I can transition into case management nursing?Dec 16, '17Quote from LuKeeUIt's a sad truth that the conventional wisdom that more experience/education in nursing, while usually enabling one to provide superior nursing care, actually can hinder one's employment prospects from the point of view of an employer's prejudice.Maybe they feel that you're OVER qualified. That's not a bad thing to me, however, some employers want someone they can teach. Have you heard the saying "You can't teach an old dog new tricks?"
You'd think that they'd appreciate a fully experienced nurse, but alas... it is what it is. I hope you find the job you want.
I'm sure patients/clients would benefit from having an experienced certified case manager, and I can't imagine how having a MSN wouldn't be beneficial. Alas, what is best for patients/clients is not always the most important consideration from an employer's point of view, much as we as nurses are always strongly encouraged/advised to further our education, certifications, and experience to make ourselves more valuable to patients and employers.Dec 16, '17Quote from sandi917Sandi917,I have to say that i have applied multiple times to multiple work at home job postings for an experienced case manager. I have yet to even receive a call for an interview. I have only received auto reply emails thanking me for my interest in the position. I have an MSN, CCM and experience as a case manager, so I am not sure why I seem to be having difficulty! My point being that it is not as easy as it seems....at least that has been my experience!
It can be very difficult to get a work from position. I do work from home, but I have applied for other work at home positions and never received a call back. I also have a Masters and a CCM and I agree with the comment that they may feel these credentials mean you are over-qualified or at least looking for more money than what they want to pay.
But, don't give up! Never give up looking for something that fits your life! ~MelissaDec 16, '17Quote from Nurse olamideNurse olamide,How do I get a job as case manager nurse?
It really depends on what type of nursing you currently do and what kind of CM job you are looking for. How much experience as a nurse do you have? Research different types of CM jobs and choose one that suits your experience the best.
Provide a bit more info for me through here and I would be happy to help you brainstorm some ideas of CM jobs that may be a good fit for you. ~MelissaDec 16, '17Quote from Anon101Hi Anon101,Thanks for the article. I'm a new graduate registered nurse and have realized that bed-side nursing isn't really for me. Do you have any tips as to how I can transition into case management nursing?
Many case management positions want you to have a full year of nursing experience before you become a CM. This is just to give you time to better your assessment skills and start to understand the healthcare system as a whole. CMs are very well-versed in the healthcare system, insurances, Medicare and Medicaid as well as community resources. So, while you are getting more experience, really spend time learning more about our healthcare system in a global sense.
Do you know anyone who is a case manager? Maybe someone at your current job? Talk to them about what kind of roles are available where you are and see if you qualify. I know that many nurses I work with started in home care. For me, home care gave me that autonomy I desired. I could make my own schedule and work independently. Have you thought about home care?
Another great way to get more information is to complete a few CE courses on case management. This will give you a better idea of what case managers do and if you would enjoy this kind of work. Let me know what kind of CM positions you have researched. ~MelissaDec 16, '17Thanks for this enlightening article. Made my day because I am at a career cross-road. Looking to transition from home health case manager/intake nurse to telecommuting work at home case manager. A few of the readers asked about 'how to find these jobs'. There are several insurance companies such as Aetna and Humana. Check their web sites. There is also Flex Jobs. They charge an annual fee, but you would be pleasantly surprised at the number of work at home jobs and employers that they work with. Good luck!
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