Should You Become a Nurse Case Manager?

This is a guest post by Susan White.

There are various reasons why registered nurses and others in the nursing profession switch to nonclinical jobs – they’re too stressed out because of the nature of their work and the long hours they have to put in, they suffer from various health problems that prevent them from doing justice to their jobs, or they just don’t have the mental tenacity to deal with patients and their problems on a daily basis. Whatever the reasons for the change, nurses do it because they still want to stay close to the medical field even if they no longer have any kind of direct interaction with patients. But if they’re looking for a job that’s less stressful and easier on their schedule, perhaps they should rethink becoming a nurse case manager.

Case management nurses look after the treatment details of certain patients with specific diseases. Their responsibilities include:
• Coordinating care plans for patients with diseases like cancer, AIDS and Alzheimer’s and even those who are recovering from a major surgeries or accidental injuries – the case manager must ensure that the patients in their care are treated according to protocol and are provided customized care based on the nature of their disease or injury.
• Managing health services for patients after they’re discharged from the hospital – this includes ensuring that they have all they need to continue receiving care at home, including specialized equipment and caregivers.
• Dealing with insurance companies on behalf of the patient to ensure that their policy covers home health care, medical equipment, rehabilitation services, and a healthcare professional as a caregiver if necessary.
• Dealing with the insurance companies on behalf of the healthcare facility that employs them to explain why the care provided was necessary and so ensure reimbursement for healthcare services provided.
• Helping relatives, family and caregivers understand the need for and the nature of the care provided.

Case management nurses also work for government agencies and insurance companies to ensure that there is no fraud being committed by healthcare facilities and that the treatment provided was necessary and/or the patient is not faking his/her injury or condition. Some also work with hospice caregivers and home health caregivers to coordinate care for patients based on accurate and timely assessments and feedbacks and discussions with the concerned doctors.

If you want to become a case management nurse, you would probably have to pursue an additional degree, either to learn management aspects of nursing and/or to gain more knowledge about certain diseases. So if you don’t have the time or the money to go back to school, then you should consider staying on in nursing or switching to another nonclinical job. Besides this, you should remember that your workload is not going to get any lighter – while you may not be directly involved in patient care, you are responsible for their wellbeing; this job too is stressful, so if you’re quitting nursing to avoid stress, this is probably not the right alternative for you.

Choose to become a nurse case manager only if you enjoy the challenge, have the necessary skills to deal with both patients and administrators, are a good coordinator and facilitator, and have excellent communication skills.

This article is contributed by Susan White, who regularly writes on the subject of surgical technician schools. She invites your questions, comments at her email address: susan.white33@gmail.com.