What does a Case Management Nurse do?

A case management nurse is a registered nurse (RN) who works with patients who have chronic health issues, helping develop and coordinate a medical plan of care in a manner that is both beneficial to the patient and is cost effective. Case management nurses can be found in several environments, including insurance companies, hospitals, rehabilitation centers, mental health centers, and long-term care facilities. After implementing a patient care plan, it usually is the responsibility of the case management nurse to regularly check in to make sure the plan is running smoothly, as well.

One common duty of a nurse case manager is to facilitate communication with other disciplines. A hospice case manager, for instance, might contact a patient's physician to let him or her know if the patient develops new symptoms or requires new medications. The case manager might also contact the team social worker to report a financial issue and the team chaplain to report a spiritual need.

Another duty of a case management nurse is to coordinate care and arrange for services. An insurance case manager might approve procedures and make surgical appointments for patients with certain conditions, or an oncology case manager might arrange for a patient to receive radiation or chemotherapy. This saves the patient the trouble of having to fight his or her way through the system to get the appointments and care he or she needs.

A case management nurse typically acts as the primary contact for a patient. If a need arises, or if there is a problem with services, the patient contacts his or her case manager and the case manager works to resolve the issue. Again, this helps take some of the burden off of the patient who might already be struggling with a serious medical condition.

Once a plan of care has been developed and put into action, the case management nurse is responsible for assessing the patient regularly to make sure the plan of care remains appropriate. If the patient's condition has changed, the plan of care will often have to be changed, as well. For instance, a psychiatric patient who was being successfully maintained on quarterly medication checks may have devolved to the point where he or she requires weekly appointments or inpatient stabilization.

The case management nurse is usually responsible for insuring that treatment for a given patient is cost effective as well as medically effective. A case manager may be put in the difficult position of declining a request for treatment if the expense is great and the expected benefit is slight or questionable. Case managers who work for an insurance company are especially likely to run into this type of dilemma.