Sandra Louise Bonner

Expert Case Manager: A Voice for the Voiceless

Written by Sandra L. Bonner, MSN, BSN, RN, CLNC, CCM, AGPCNP

How to Become a Case Manager

"Case management is a professional and collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual's health needs. It uses communication and available resources to promote health, quality, and cost-effective outcomes in support of the Triple Aim: improving the experience of care, improving the health of populations, and reducing per capita healthcare costs."

(CCMC, 2015, p. 4)

By learning more about case management, you can decide whether becoming a nurse case manager is the right career path for you.

There are four main types of case management roles:

1. Nurse Case Managers
2. Disability Case Managers
3. Rehabilitation Case Managers
4. Education Case Managers

I. Nurse Case Managers

Nurse case managers:

• Work in hospitals and healthcare facilities.
• Work in long-term care settings.
• Have a background as registered nurses.
• Review clients' medical records, histories, and documentation to evaluate appropriate treatment options.
• Establish patients' care plans from admission through discharge.
• Oversee treatment plans and coordinate care.
• Organize the discharge process to ensure patients transition safely back to their home environments.

II. Disability Case Managers

Disability case managers:

• Work for social service agencies or healthcare organizations.
• Assist clients with disabilities in navigating treatment options.
• Help clients understand insurance benefits and resources.
• Meet with clients in their homes or healthcare facilities to discuss concerns and needs.
• Support clients as they transition back to home, school, or work.
• Assist in coordinating home or workplace modifications to improve accessibility.

III. Rehabilitation Case Managers

Rehabilitation case managers:

• Work in rehabilitation clinics or social service agencies.
• Help individuals identify resources needed to overcome addictions, injuries, or illnesses.
• Monitor the implementation of treatment plans.
• Ensure clients receive appropriate, high-quality care.
• Network with healthcare providers, community agencies, and support organizations to connect clients with additional resources such as counseling services and support groups.

IV. Education Case Managers

Education case managers:

• Advocate for students with autism, Down syndrome, dyslexia, and other learning disabilities.
• Ensure students receive appropriate educational resources and accommodations.
• Collaborate with family members, educators, and social service personnel.
• Develop and coordinate Individualized Education Programs (IEPs).
• Follow up with families to ensure students receive the services they need to succeed.

How to Become a Case Manager

Most nurse case manager positions require:

• A Bachelor of Science in Nursing (BSN)
• An active registered nurse (RN) license
• Relevant clinical experience

Many employers also prefer or require certification.

Obtain Your CCM Certification

The Certified Case Manager (CCM®) credential is considered the gold standard in case management certification.

Why Become a Nurse Case Manager?

Case Study

A nurse case manager received a workers' compensation case involving an over-the-road truck driver who sustained a work-related injury.

The injured worker missed a step while climbing into his truck and landed on his left elbow. He was initially treated at an urgent care clinic for a left elbow contusion.

After failing to improve over the following month, he was referred to an orthopedic elbow specialist and was diagnosed with a torn biceps tendon.

The nurse case manager was assigned to schedule and attend the referral appointment for further evaluation.

During the face-to-face interview at the orthopedic appointment, the nurse case manager discovered something unexpected: the injured worker may have had a rare blood disorder that had been misdiagnosed for years.

With the injured worker's permission, the nurse case manager remained in the examination room during the physician's evaluation. After completing a thorough medical history and examination, the orthopedic surgeon recommended surgery to repair the torn tendon.

The nurse case manager then shared her concern that the injured worker's history suggested the possibility of a rare bleeding disorder.

Case Management Impact

The nurse case manager:

• Coordinated the orthopedic appointment using the injured worker's physician of choice.
• Expedited scheduling through the workers' compensation liaison.
• Arranged to attend the appointment with the injured worker.
• Contacted the injured worker 24 hours before the appointment to confirm the date, time, location, and transportation arrangements.

While assisting the injured worker with completing new patient paperwork, the nurse case manager reviewed his medical history and noticed that he denied a history of bleeding disorders.

However, he also reported that his spleen had been removed 20 years earlier while serving in the Army.

When asked why the procedure had been performed, he replied:

"The doctors thought it would help me not be a free bleeder when I had dental work."

When asked whether the splenectomy had resolved the problem, he responded:

"No. I still have to get transfusions whenever I have dental work. Everybody in my family has it. All twelve of my brothers and sisters have the same problem."

The nurse case manager then asked whether he had ever been diagnosed with thrombocytopenia.

"Yes, I think that's what they called it," he replied.

As a seasoned nurse using critical-thinking skills, the nurse case manager began connecting the dots.

If all of the injured worker's siblings had the same disorder, the condition was likely genetic.

After examining the patient, the orthopedic surgeon agreed to order a complete blood count (CBC) with differential before surgery.

The nurse case manager notified the claims adjuster, provided a medical update, and obtained authorization for the laboratory work.

The results revealed a critically low platelet count of 17,000. A normal platelet count ranges from 150,000 to 450,000.

Recognizing the urgency of the situation, the nurse case manager requested a referral to a hematologist/oncologist.

She obtained authorization from the adjuster, researched available specialists, and secured an appointment for the injured worker the following day.

A Rare Diagnosis

The nurse case manager attended the hematology appointment with the injured worker.

After obtaining a detailed medical history, the hematologist examined the injured worker's blood under a microscope.

He returned to the examination room and stated that he could hardly believe what he was seeing.

The injured worker was diagnosed with Bernard-Soulier syndrome.

The physician explained that the condition was extremely rare, with fewer than 200 reported cases in the United States.

Additional testing confirmed a platelet count of 14,000.

Bernard-Soulier syndrome is a rare inherited bleeding disorder transmitted in an autosomal recessive pattern. Both parents must carry the affected gene and pass it on for the child to develop the disorder.

The condition is associated with abnormally large platelets and reduced platelet numbers, a combination known as macrothrombocytopenia.

The hematologist recommended that the injured worker receive specialized platelet transfusions before surgery until his platelet count reached 54,000.

The Outcome

Following successful surgery, both treating physicians stated that it was unlikely the injured worker would have survived the procedure without the nurse case manager's advocacy and persistence in obtaining the correct diagnosis.

Four months later, the injured worker—the primary provider for his family—returned to his original position as a truck driver with the same employer.

He was grateful and relieved.

As a result of the nurse case manager's exceptional care, the adjuster, physicians, and employer recognized her outstanding advocacy and dedication to the injured worker's well-being.

Because of her quick action, diligence, and commitment to patient advocacy:

• The injured worker received an accurate diagnosis.
• Appropriate treatment was initiated.
• Surgery proceeded safely within a week.
• The case achieved approximately $27,000 in cost savings.
• The injured worker returned to work within 60 days.

Why Get Certified?

The CCM® is the largest, oldest, and most highly respected credential for case managers.

As healthcare evolves toward a more patient-centered, coordinated model of care, organizations increasingly recognize the value of knowledgeable, well-trained case managers.

Salaries for CCM-certified professionals continue to rise.

• Most CCMs earn more than $80,000 annually.
• More than half of CCM executives earn over $100,000 annually.
• More than one-third of CCMs in management roles earn over $100,000 annually.

Certification offers benefits beyond salary.

Benefits of CCM Certification

• 88% of CCMs report that certification has positively impacted their careers.
• 94% recommend the CCM credential to other case managers.

CCMs pursue certification to:

• Improve employment opportunities
• Advance their professional standing
• Enhance personal growth

The CCM is widely recognized as the mark of excellence in case management.

It is:

• Endorsed by the National Association of Social Workers and the Case Management Society of America.
• The only cross-setting, cross-disciplinary healthcare case management credential accredited by the National Commission for Certifying Agencies.
• The only cross-setting case management certification validated through a comprehensive job analysis conducted by independent experts.

Employers recognize the value of certification:

• 58% pay for case managers to take the CCM examination.
• 44% require the credential.
• 43% pay for CCM renewal.

CCM-certified supervisors and employers consistently identify the credential as a valuable indicator of professional competence.

If you want to become a case manager, you should understand the education, licensure, and certification requirements in your state and within the type of organization where you hope to work, such as hospitals, insurance companies, rehabilitation facilities, or home healthcare agencies.

In most cases, you'll need a professional background in nursing, social work, or another related field. The specific requirements, however, vary depending on the position you pursue.

For example, nurse case managers must maintain active nursing licenses in every state in which they provide services. Depending on the scope of practice and employer requirements, this may involve obtaining multiple state licenses or participating in the Nurse Licensure Compact.

In addition to education and licensure requirements, many employers require professional certification, such as the Certified Case Manager (CCM®) credential from the Commission for Case Manager Certification or the Accredited Case Manager (ACM®) credential from the American Case Management Association.

References

Commission for Case Manager Certification (CCMC). (2015). Code of Professional Conduct for Case Managers with Standards, Rules, Procedures, and Penalties.

Ethical principles and professional standards established by the CCMC apply to individuals holding the CCM® credential and guide case managers in delivering competent, ethical, and patient-centered care.