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!
SpecialtiesCase ManagementArticle
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:
Caseload Management
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.
Conduct Assessments
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.
Care Coordination
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.
Patient Advocate
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:
