Nurse Case Manager

A nurse case manager is an occupation that combines the skills of a nurse and a social worker. They are expected to provide assessments for patients and tap resources to help with patient care. They are not only knowledgeable about healthcare but are also well-versed in understanding medical systems, insurance coverage, and hospital regulations. The majority of nurse case managers are employed by general and specialty hospitals, but other agencies like insurance companies have been known to employ them as well.

A nurse case manager essentially arranges for the care and treatment of individual patients. They review available resources and choose the best options for the patient. They advocate on the patient’s behalf and will communicate with families, healthcare providers, and insurance companies to develop an effective plan for treatment. Nurse case managers typically start off as registered nurses (RNs ) before entering the field.

On the job, they are assigned to certain patients who require specialty care. For instance, a nurse case manager may be asked to assist a hospital patient who is moving into a nursing home.

Nurse case managers make patient care recommendations to families after assessing the needs of the patient. They collect information from the patient, medical providers, and insurance companies to give safe and effective care recommendations. Their goal is not only to make decisions to improve the health of the patient but also to confirm recommendations are fiscally responsible. Caseloads for a nurse manager vary and will depend on where they are employed.

If working for a hospital, they will perform duties that likely include:

• Insurance coverage reviews
• Identify patient needs and offer resources

Since the nurse case manager makes medical recommendations, he or she needs to be a registered nurse. A registered nurse will have the capacity to review healthcare plans and provide clinical decisions on routine matters. For more serious medical issues, the case manager will get in touch with the patient’s physicians.

Besides hospitals, nurse case managers are employed by nursing homes, rehabilitative centers, hospices, home health agencies, and insurance providers. They perform the same duties in these settings as they do in a hospital, but the resources available may vary.

Nurse case managers are given the responsibility of getting patients the best care possible. They are needed to educate patients and their families about healthcare options and whether insurance will cover the patient care needed. They review charts to assess patients and update care plans as needed. Patients and families may go to the nurse for emotional support and medical advice.

This is why it’s important for the nurse case manager to have deep knowledge about symptoms, treatment options, medications, and procedures. Plans created by nurse case managers are always supposed to be centered on the patient and designed to serve his or her best interests. They must follow an ethical code to confirm their decisions are not made due to outside influences.

A nurse case manager needs to have a compassionate, caring personality. In all situations, the professional should have the capacity to put the patient first. Nurse case managers must be detail-oriented since charting is a big part of their job descriptions. They must be a strong communicator since they will need to work with patients, families, doctors, and insurance companies to develop a care plan.

Case managers are also resourceful since the job often requires them to look at a variety of options and choose the one most likely to offer the best possible outcome.

The educational background for a nurse case manager will start out the same way as an RN. Prospective nurses will enroll in a nursing degree program from an accredited college or university. Most hospitals and senior care facilities prefer nurse care managers have a Bachelor of Science in Nursing (BSN ). Associate degree programs are also…