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Nursing Case Management

Nursing case management is one of the many nursing specialties available. Case management can include a variety of different positions.

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Definition of Case Management

The Case Management Society of America's (CMSA) definition of case management as published on their website is:

"Case management is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes."

Nursing CM positions may be hospital or community based.
Hospital based case managers are often involved in utilization review, discharge planning and care coordination.

You will:

  • evaluate admissions for medical necessity
  • provide clinical information to payor sources to obtain authorization for the hospital stay
  • work closely with the medical team in following the plan of care
  • assist with creating a safe and cost effective discharge plan
  • assess the patients benefits for proper utilization of services
  • set up home health services and equipment

Community based case management may include working for insurance companies, home health agencies, or case management companies.

Insurance companies have a variety of case managers.

You may:

  • perform onsite clinical reviews at your assigned facilities
  • perform telephonic clinical reviews for your assigned facilities
  • assist the hospital CM with discharge planning

Home health company CM's are often in supervisory positions.

You may:

  • perform the admission assessment to home health
  • obtain insurance authorizations
  • obtain physician orders
  • coordinate the patient's plan of care
  • assist with acquiring additional services as needed
  • perform supervisory visits as mandated
  • perform additional visits and call patients as needed

Nursing Case Management Certification

As with many nursing specialties you may become a certified nurse case manager by taking a certification course and exam. This specialty has several types of certifications depending on your goals as a case manager.

The American Case Management Association exam (ACM) is focused on hospital case management.

The Commission for Case Management Certification exam (CCM) covers a wider range of case management knowledge including inpatient and outpatient case management.

Your case management certification will allow you to state you are certified on your nursing license renewal and you are then required to complete your nursing CEUs according to the requirements for your certification.  Example my ACM certification requires that I have 40 hours every 4 years and most need to be related to case management and ACM approved and the others can be nursing related in my practice area.

Free Case Management CEU's

Case Managers, check out this FREE 2 hour course from AACEUs.  Code of Professional Conduct for Case Managers.  This is an ethics course so I found I needed some quiet to focus on it.  Reading anything that includes legal language usually requires my full attention.

Coram, a home health care company offers a variety of free webinars and courses. One of the current offerings is  Overcoming Barriers to Discharge for home infusions for 2 hours.

› Case Management


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