What Is Case Management Certification?
Those working as registered nurses (RNs) may want to further develop their skills to take on a role as a case manager. In order to work in case management, RNs are required to hold specific certification gained through intensive coursework designed to prepare them for their future careers. Case managers provide invaluable services to patients and work across a wide variety of medical disciplines. To enter a program either online or on-campus, nurses must already possess certain skills and experience to be considered for future certification.
Requirements for RN Case Management Certification Programs
While RNs can work after earning only an Associate of Science in Nursing (ASN), many RNs will pursue a Bachelor of Science in Nursing (BSN) to better prepare themselves for a career in health care. Nurses can become certified for case management by either entering a university program, or earning their certificate through the American Nurses Credentialing Center (ANCC). Depending on the university to which nurses apply, they may be required to hold additional degrees, experience, or training to be considered. However, the ANCC allow nurses to start earning their certificate in case management with the following minimum requirements:
- Active RN license
- At least two years of full-time practice
- Minimum of 2,000 clinical hours and 30 hours of continuing education in case management.
Topics Learned in Case Management Studies
RNs who are certified as case managers must be able to apply their knowledge to a number of different medical disciplines in order to provide their patients with the highest quality care. Nurses pursuing their certification either online or on-campus in case management will cover the following topics:
Legal, Financial & Business Issues in Health Care
Case management nurses must act as advocates for their patients, striving to provide them with the education and tools they need to access high-quality health care. To achieve this end, nurses must be well-versed in the legal, financial, and business issues that affect patient access to care. Additionally, knowledge in this area will allow nurses to make more prudent business decisions for their teams and medical practices.
Insurance Lines & Health Benefits
Because case managers must often act as the liaison between patients and their insurance providers, knowledge of insurance lines and health care benefits is a must for nurses to be successful. Through this coursework, nurses will better understand how to ensure that their patients can gain access to the care they need at a fair and reasonable price. Nurses will also learn how provider contracts and terms can impact the success of the medical practice overall — especially in terms of accounts receivable and patient billing.
As patient advocates and care providers, case managers are expected to increase their quality of life not only through the level of care they provide, but also in terms of enacting significant change within the health care system. In understanding the challenges their patients face, they can more easily illustrate to their medical practices how certain policies are affecting the patient population and the best methods for implementing meaningful change. Additionally, case managers must use their skills in social work to provide their patients with education and resources necessary to facilitate continued care.
Advanced Illness Management
Case managers will often work with individuals who have advanced diseases, such as Alzheimer's, dementia, heart disease, or diabetes. For this reason, nurses need to understand the best practices used in long-term care to develop the best treatment plan for their patients. Nurses will need to understand the severity involved in advanced illness treatments, and be able to assist families through the decision-making process as they face more complex medical situations.
Mental Health & Substance Abuse
RNs working towards certification in case management will also learn about mental health treatment and substance abuse prevention methods. While nurses will need special certification in order to administer mental health care, case managers still are required to understand the interventions used in treating such patients and the resources they have available to pursue continued care. They will also need to understand the signs of underlying mental illness or substance abuse behaviors in order to best coordinate their care with their medical team.
How to Choose a Certification Program
When selecting a case management certification program, RNs must first ensure that the program is accredited by the Accreditation Board for Specialty Nursing Certification. Since program participants are active professionals, RNs should consider whether or not the program is offered online or has flexible course schedules to accommodate their work and life obligations. The program should offer sufficient clinical experience to meet the ANCC eligibility requirements for certification. Additionally, nurses should feel confident that the program offers education across a wide variety of disciplines so they may pursue case management within the health care setting of their choice.
Available Careers in Case Management
Case managers can work in a number of medical settings due to the fact that their coursework covers many different health care disciplines. While the United States Bureau of Labor Statistics (BLS) does not provide information specific to case managers, registered nurse employment is expected to grow by 12% between 2018 and 2028. The average registered nurse in America earns $71,730 annually; however, depending on the specific career path of a case manager, this figure may change. Candidates earning their certification in case management can pursue a number of careers, including: