Why Consider Case Management as a Career Path?

Judy Campbell

Versatility is one of the greatest benefits of becoming a nurse. Some nurses know what type of nursing they want to do from the start. Someone who is adventurous and enjoys an adrenaline rush may be suited for the emergency room. Someone who is fascinated by pregnancy and newborns may sway towards labor and delivery. Someone who prefers to gather information, work on experiments, and analyze data may explore the field of research. There is an abundance of possibilities that nurses can explore.

After I had a few years of bedside nursing under my belt, I decided to apply for a case management role. I was able to use all the knowledge that I gained from long-term care, skilled nursing, acute care, and community health all in one place. I felt that I had a pretty good grasp of how patients transition from one setting to another.

According to the Commission for Case Management Certification (CCMC), case management is the “process that manages client wellness and autonomy through advocacy, communication, education, and the identification and facilitation of services.” Case managers seek to ensure patients are receiving the right care, at the right time, in the right place. Case managers are responsible for ensuring resources are accessible, cost-effective, and efficient.

Hospital Case Management

At the hospital, the staff would call us the “hospital quarterbacks.” As a nurse who previously worked on a Med-Surg unit, I always assumed that the hospitalist would determine a patient’s discharge date. As a case manager, I learned that while the physicians did play a role in the discharge plans, the case managers assist with “orchestrating” the end-to-end process.” From the time of admission, case managers are assessing what a patient’s needs are, who their support is and will be, and what their risks for readmission to the hospital are. Case managers evaluate and coordinate visits, treatments, medication, and overall care. Case managers work with healthcare payers to determine the scope of treatment and coordinate care options.

Case managers help with developing a care plan and ensuring a safe discharge. Would the patient benefit from rehab at a nursing facility? Would they qualify for it? Would the patient be safe going home and receiving therapy at home? What happens if a patient has no support available and cannot return home? These questions (and a hundred more) are what case managers consider from the time of admission.

Community Case Management

Often, the success of a patient’s ongoing health depends on the ability and strength of their social safety net. Patients with limited social connections or complex treatment plans often encounter barriers in remaining at home. Family members are sometimes unable to actively participate in managing care due to other obligations. Case managers strive to fill in those gaps by providing community resources, linking patients to specialty providers, and ensuring that patients have the right tools to manage their care.

Case managers also get involved in more preventative medicine. Many case managers enjoy coaching, educating, and developing care plans for patients. Case managers often become advocates for their patients and become an essential part of their support system.

Chronic Care Management

Chronic diseases and conditions, meaning it has lasted for more than a year, requires ongoing monitoring and medical attention. It may also affect a patient’s day-to-day activities. Chronic care management includes a thorough review of a patient’s chronic condition, personal information, goals of care, providers involved, medication, and any other medically necessary services. In the United State, chronic care management involves face-to-face visits, ongoing communication, and coordination of care. These chronic conditions include diabetes, renal failure, and heart disease.

A diabetes case manager can effectively improve clinical outcomes and quality of life by getting involved with a patient’s interdisciplinary team, focusing on self-care education, and working alongside each patient on their patient-centered goals. The American Association of Diabetes Educators developed seven diabetes self-care behaviors, which include healthy eating, being active, monitoring, taking medication, problem-solving, healthy coping, and reducing risks as behavior. A diabetes case manager would cover all these areas in hopes to

Four important factors will continue to impact the practice of case management.

1. Explosion of managed care

2. Greater demands for geriatric care

3. An Increasing number of chronically ill patients with the simultaneous emergence of newly developed drugs and requiring complex, ongoing treatment.

4. Spread of state legislation requiring certification and licensing.

Ongoing Need for Case Managers

The demand for certified case managers who can manage complex cases in the best interests of patients and incorporate cost-effective solutions to quality care will continue to grow. Case management is a cross-disciplinary specialty practice. Case management is guided by the ethical principles of nursing and strives to improve healthcare delivery through advocacy, communication, education, and service facilitation.

Case management is a career path focused on developing a long-term rapport with patients in all stages of their life. As a case manager, I am fulfilled by ongoing learning and challenges that reignite my curiosity, critical thinking, and creative skills. In our evolving health care system, case managers are necessary for identifying risks, aligning necessary health services for patients who need them the most, and educating patients to be more conscious of their overall health.

Resources

Introduction to the Case Management Body of Knowledge

What is Chronic Care Management?

Diabetes Case Management

Diabetes Case Manager Interview Guide