What does a Nurse Case Manager do?

Article Details
  • Written By: Mona D. Rigdon
  • Edited By: A. Joseph
  • Last Modified Date: 04 November 2019
  • Copyright Protected:
    Conjecture Corporation
  • Print this Article
Free Widgets for your Site/Blog
The Health and Retirement Study shows that 56% of Americans over 50 leave their jobs before being ready to retire.  more...

December 5 ,  1933 :  Prohibition ended in the US.  more...

A nurse case manager is a licensed nurse who coordinates patient care in a specific setting in order to provide optimal treatment. These managers work in a variety of fields with different specializations. The most common type of job position in this field is in a hospital or other general medical care facility. Other case managers work in retirement homes, rehabilitation centers, insurance companies, government agencies or hospices.

There are many specialties on which a nurse case manager can focus educationally and career-wise. For example, cancer patients have a specific set of needs that differ from those patients who might be suffering from Alzheimer's or those recovering from a major surgery. For this reason, nurses in the case management arena generally focus continuing education studies accordingly in order to provide the best care to those they serve. Examples of focused areas of care include surgical care, cancer treatment, AIDS, geriatrics, pediatrics, burn care, wound care and hospice care.


Common tasks assigned to a case management nurse differ with each field of specialty. In a hospital, a nurse case manager is in charge of coordinating care plans and health services upon discharge from the hospital. Generally, he or she must also act as an advocate for the patient with insurance companies in order to ensure home health care, medical equipment and rehabilitation services are covered after discharge. The case manager also helps insurance adjusters understand care provided and the necessity of it in order to ensure that the facility is reimbursed properly. Many times, these managers must also help family members, friends or other members of a patient's support system understand a condition, diagnosis, need or procedure.

Case managers who work for insurance companies or government agencies might have somewhat varying duties. Although these nurses must also work to ensure that patients receive proper care and that appropriate reimbursement is made for that care, they also have to watch for fraud. An insurance industry nurse case manager must ensure that the care provided is appropriate, approved and properly billed. Insurance fraud is not uncommon, even by hospitals and other reputable health care facilities. Worker's compensation case managers must ensure that patients receive appropriate care but also ensure that they are not faking the injury or illness that they claim occurred as a result of work.

Home health case workers and hospice workers have a unique type of case management with which to contend. They often act as the eyes and ears for the doctor, and as such, they must provide detailed, accurate assessments. From these assessments, the nurse case manager and the doctors will coordinate, plan and implement a care plan. This care plan often involves family members or friends, so a case manager must act as a teacher in this regard as well.

No matter the specialty of the nurse, working in the case management field requires specialized education and skills. Critical thinking, assessment and communication are crucial skills to ensure successful interaction and coordination between doctors, patients, family members and the case manager. Dedication to the patient, education and the employer also are key attributes for a nurse case manager to possess.


You might also Like


Discuss this Article

Post your comments

Post Anonymously


forgot password?