August 9, 2022
By: Kathleen Gaines News and Education Editor, MSN, RN, BA, CBC
A Nurse Case Manager, also known as a care coordinator, specializes in the organization and collaboration of patient care and treatment by all members of the care team.
Often, patients will be managed by multiple specialties and there will be numerous doctors involved. The case manager will ensure all of them are working as a team to provide the best care for the patient. In this guide, we'll cover everything you need to know about what a case manager is, what they do, and how you can become one.
A case manager is a specialized Registered Nurse (RN) that works with patients and providers to determine the specific care that is required and the best options for that care. Through a collaboration with multiple specialties, case managers ensure the patient is receiving quality medical care.
Each patient’s case is looked at individually because the needs of the patients will vary depending on their underlying chronic health condition. Case Managers act as patient advocates and make sure the needs of the patient are met effectively and efficiently.
According to payscale.com, the annual salary for an RN case manager as of July 2022 is $75,744 per year or roughly $36.28 per hour, though salaries vary by area.
Case Manager Pay by Levels of Experience
Payscale.com indicates the following pay by experience level for care managers:
- Less than 1 year of experience can expect to earn an average of $67,555
- 1 to 4 years of experience earns an average total compensation of $71,659
- 5 to 9 years of experience earns an average total compensation of $74,470
- 10 to 19 years of experience earns an average total compensation of $77,255
- 20 years and higher experience employees earn an average total compensation of $80,547
Highest Paying Cities for Case Managers
Case managers have reported the highest salaries in the following locations as of July 2022 according to ZipRecruiter,
- San Jose, CA - $91,117
- Oakland, CA - $90,109
- Hayward, CA - $88,340
- Seattle, WA - $88,084
- Barnstable Town, MA - $86,942
- Concord, CA - $86,849
- Sunnyvale, CA - $86,828
- Wasilla, AK - $86,147
Case Managers are generally salary-based employees. While some healthcare systems will pay an hourly rate, this is rare for this position. Those paid on an hourly scale are able to earn overtime pay whereas salaried employees would need to discuss that with the hiring committee.
As with all jobs in the nursing field, earning potential increases with additional education and experience. Nurses typically are awarded a raise during annual employee performance reviews. Certifications can give nurses an additional bump in their paycheck.
Due to the fact this is a salary-based position, the earning potential is not as high as a bedside nurse. There are fewer opportunities outside of annual performance evaluation raises and cost of living increases.
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Step 1: Graduate from an Accredited Nursing Program
The first step to becoming an RN case manager is becoming a registered nurse. To do that, you’ll need to start by earning either your ADN or your BSN from an accredited nursing program.
Step 2: Pass the NCLEX-RN
Next, you’ll need to take and pass the NCLEX-RN examination in order to become a Registered Nurse.
Step 3: Gain Nursing Experience
In order to get the skills and qualifications you’ll need as an RN case manager, you’ll need to get at least 5 years of nursing experience under your belt.
Step 4: Get a Position that Specializes in Case Management
While you’re earning your experience, you’ll also want to obtain a position that specializes in case management.
Step 5: Earn Your Certification in Case Management
There a multiple options for certification for Case Managers. See below for more information about each certification option.
1.) The Commission for Case Manager Certification (CCMC)
The Commission for Case Manager Certification (CCMC) offers advanced certification to case managers that meet the eligibility requirements.
In order to be eligible to sit for the exam, individuals must meet the following criteria:
- Category 1: 12 months of acceptable full-time case management employment experience supervised by a board-certified case manager who has been certified for at least 12 months. Supervision is defined as the systematic and periodic evaluation of the quality of the delivery of the applicant’s case management services. OR
- Category 2: 24 months of acceptable full-time case management employment experience. (Supervision by a CCM is not required under this category). OR
- Category 3: 12 months of acceptable full-time case management employment experience as a supervisor of individuals who provide case management services. Acceptable employment experience MUST meet the following conditions:
- At least 20% of qualified work time must focus primarily on case management practice.
- Perform at least four of The Five Core Components of Case Management. Within each of the four of the five core components, you must:
- Perform all Eight Essential Activities with Direct Client Contact
- Provide services across a continuum of care, beyond a single episode of care that addresses the ongoing needs of the individual being served.
- Be responsible for interacting with other relevant parties within the client’s healthcare system.
- Your qualifying case management experience MUST be obtained in the United States, Puerto Rico, or the US territories.
- Internship, preceptor-ship, practicum, and volunteer activities are NOT acceptable employment experience.
2.) ANCC Nurse Case Manager Certification (RN-BC)
Another certification available for RN Case Managers is the ANCC Nurse Case Manager Certification (RN-BC).
To be eligible to sit for the RN-BC exam, nurses must meet the following criteria:
- Hold a current, active RN license in a state or territory of the United States or hold the professional, legally recognized equivalent in another country.
- Have practiced the equivalent of 2 years full-time as a registered nurse.
- Have a minimum of 2,000 hours of clinical practice in nursing case management within the last 3 years.
- Have completed 30 hours of continuing education in nursing case management within the last 3 years.
3.) American Case Management (ACM) Certification
The American Case Management Association (ACMA) offers the American Case Management (ACM) certification to qualified individuals. According to the ACMA, this certification is unique among Case Management certifications because the examination:
- Specifically addresses Case Management in health delivery system settings
- Tests core Case Management knowledge that is shared by Nurse and Social Work Case Managers, as well as competency in the individual skills of each professional background
- Utilizes clinical simulation testing methodology to test “competency beyond knowledge” – testing critical thinking skills and the ability to use knowledge in practical situations.
To be eligible to apply for the certification examination, nurses must meet the following eligibility criteria:
- A Registered Nurse (RN) applicant must possess a valid and current nursing license that is in good standing. RN applicants must provide a nursing license number, state and expiration date.
- All applicants must have at least one (1) year**, or 2,080 hours, of supervised, paid work experience employed as a case manager, or in a role that falls within the Scope of Services and Standards of Practice of a case manager, by a Health Delivery System.
- **Candidates with less than two (2) years of experience must provide supervisor contact information and an attestation that they have at least one (1) year of supervised case management experience on the ACM application. The NBCM recognizes that because case management experience, supervision and education vary, some case managers may be qualified to sit for the exam after only one (1) year of experience.
4.) Certification in Care Coordination and Transition Management (CCCTM)
The last certification option for Case Managers is through the Medical-surgical nursing certification board. The Certification in Care Coordination and Transition Management (CCCTM) is a newer certification but is a credible option for interested individuals. Eligibility requirements include the following:
- RN with a current license in the United States or territories
- and Practiced 2 years as an RN in a Care Coordination and Transition Management role
- and Accrued 2,000 hours of Care Coordination and/or Transition Management practice within the last 3 years as a registered nurse (RN)
Currently, there is no exact career outlook data for case managers. According to the BLS, in 2021, there were 3,080,100 Registered Nurses in the United States. By 2030, there will be a need for additional 276,800 nurses, which is a projected growth of 9%. With the aging population, this number is expected to be even higher.
Because RN Case Managers generally work with the older population with chronic health conditions, the need for this highly specialized field will continue to rise. Furthermore, there is an increasing need for nurses throughout the United States and this number will only continue to rise.
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Case Managers are often the glue that holds a team of healthcare professionals together. They are involved in the coordination of care of an individual patient to identify resources and services best suited for the patient.
Case Managers will often have multiple patients they manage at any given time and will continue to follow those patients if they are re-admitted. Often, the patients that are frequently hospitalized or seen in an outpatient clinic will be flagged so the case manager is aware of their presence in the healthcare system.
Case Managers generally work with patients that have chronic health conditions such as diabetes, heart disease, seizure disorders, and COPD. While it is possible for a Case Manager to work with any patient in the hospital, most of their caseload is patients that require additional monitoring and follow-up, as well as considered high risk.
Case Managers more specifically perform the following duties:
- Decrease hospitalizations for high-risk individuals
- Identifying client needs, current services, and available resources, then connecting the client to services and resources to meet established goals
- Screening clients and/or population for healthcare needs
- Collaborate with other healthcare professionals
- Assist transfer to facilities and other care environments
- Oversee systems for identifying high-risk patients through EMR, referrals, registries from health insurance payers
- Oversee the discharge process
- Book their patients’ doctor appointments and follow up to make sure they keep them.
- Serve as a resource for their patients, offering education and guidance to patients and their families as they navigate complex medical decisions.
- Develop and manage the overall long-term health care plan for patients with chronic or serious conditions such as Alzheimer’s disease, diabetes, and heart disease.
- Develop a tracking system for patient care coordination and care management across the continuum, including care transitions, Primary and Specialty Care.
- Act as clinical liaison for Payer Based Care Management programs
- Follow-up with patients within 24 hours on inpatient discharge and within 48 hours of ED visit notification
- Monitor medication usage by a patient
- Monitor and update treatment plans to reflect the patient’s current condition
- Assist patients in navigating the health care system.
- Coordinate Specialty care, follow-up on test results and other care coordination needs.
- Promote self-management goals
- Research the latest treatments and procedures in their chosen area of specialization
- Partner with external case management programs to coordinate care
- Educating the client/family/caregiver about the case management process and evaluating their understanding of the process
- Developing a client-focused case management plan
- Promote quality, cost-effective care, and patient outcomes
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Case Managers can work in a variety of settings. Most commonly they are found in the following areas:
- Insurance Companies
- Long-term care facilities
- Medical supply companies
- Palliative care
- Community health centers
- Public health centers
- Oncology outpatient centers
- Outpatient clinics
- Home healthcare companies
- Government agencies
RN Case Managers have the same continuing education requirements as other RNs. This will vary on a state by state basis. While there are no specific CEU requirements for a Case Manager, specific certifications require CEUs. If an advanced certification is held, individuals should refer to the accrediting organization’s website for specifics regarding the CEUs.
Generally, in order for an individual to renew their RN license, they will need to fill out an application, complete a specific number of CEU hours, and pay a nominal fee. Each state has specific requirements and it is important to check with the board of nursing prior to applying for license renewal.
A detailed look at Continuing Nurse Education hours can be found here.
- Case Management Society of America
- American Case Management Association
- Commission for Case Manager Certification
- National Association of Case Management
- Collaborative Case Management
What is an RN Case Manager?
- A case manager is a specialized RN that works with patients, usually with chronic health conditions, to coordinate their care during hospitalizations, outpatient appointments, and home care.
What is the Average Salary of a Case Manager?
- According to payscale.com, the annual salary for an RN case manager as of July 2022 is $75,744 per year or roughly $36.28 per hour.
What are the Five Components of Case Management?
- Care delivery and reimbursement methods, psychosocial concepts and support systems, quality and outcomes evaluation and measurements, rehabilitation concepts and strategies, and ethical, legal, and practice standards
What Qualities Should a Case Manager Possess?
- Strong time management skills, organization, effective communication skills, decision-making and problem-solving abilities, autonomy, teamwork, a creative personality, strong clinical skills and confidence
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