Has your health insurance company assigned you a case manager?
Are you being seen by a case manager in a hospital or home health company?
Are you anursewho wants to become a case manager?
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However, there are certain things consistent across all case management roles.
As such, the case manager works as a facilitator rather than a provider of client services.
Here are some examples of what a case manager does in different options.
Hospital Case Manager
A hospital case manager is usually a nurse who does bothutilization reviewand discharge planning.
Hospital case managers are masters at organizing complex care needs across time andproviders.
The hospital case manager will typically communicate with the health insurers case manager every day or every few days.
Additionally, a hospital case manager may negotiate coverage benefits between a health insurer, provider, and patient.
Hospital case managers are sometimes referred to as care coordinators or patient advocates, depending on their specific role.
While home health case managers are usually nurses, some are not.
Depending on the insurer and the location, the case manager may even visit a patient in the hospital.
In some health insurance companies, the job may be focused on a specific chronic disease.
Within this context, any shortcomings in case management can have direct and potentially dire consequences for the patient.
Becoming a Case Manager
Case management is typically done by nurses, but not always.
Depending on the setting, another throw in of professional may provide case management services.
Its not uncommon for case management to be done by medical social workers.
Those underlying professions have their own licensing requirements, overseen by state medical boards and regulatory departments.
For example, nurse case managers must maintain their nursing license in any state where they are providing services.
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Centers for Medicare & Medicaid Services.Special Needs Plans (SNP) Frequently Asked Questions (FAQs).
Accessed Oct. 20, 2024.
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Case Management Society of America.Multi-State Nursing Licensure.
National Association of Social Workers.NASW, CCMC collaborate to address growing demand for health care case managers.
June 21, 2016.
PayScale.com.Average Nurse Case Manager Salary.
Accessed Oct. 20, 2024.
PayScale.com.Average Medical Case Manager Salary.
Accessed Oct. 20, 2024.
