6 Pros and Cons of Being a Registered Nurse Case Manager + Salary + Steps to Become
Written By: Pattie Trumble, MPP, MPH
Registered nurse case managers primarily work in an administrative capacity, coordinating care for long-term patients facing multiple hospital admissions, as is often the case with geriatric patients, patients recuperating from serious injuries, or patients affected by chronic conditions like Alzheimer’s, cardiac disease, or diabetes. RN case managers organize the different services a particular patient will receive by developing care plans that are specifically tailored to those patients’ needs. Think of a nursing case manager as a cross between a social worker and a clinician. This article offers an in-depth look at the position of registered nurse case manager – what is it, how to become, salary, and the pros & cons.
WHAT DOES A REGISTERED NURSE CASE MANAGER DO?
Anyone who’s ever been hospitalized or received medical services from an outpatient care clinic on an ongoing basis knows how frustrating that experience can be. The duties of a registered nurse case manager involve making that experience less frustrating by evaluating available treatment options and choosing the ones best suited to meet a particular patient’s physical and psychological needs. Nursing case managers:
• Assess client needs
• Create care plans
• Coordinate between clients, care providers, and facilities
• Make sure clients and client caregivers understand treatment options
• Communicate regularly with clients and client caregivers to ensure treatments are meeting client needs
• Serve as a liaison with appropriate human service agencies
• Serve as a liaison with insurance providers
• Review utilization of services
• Participate when appropriate in discharge planning
RNs specializing in case management understand medical resource allocation. They multitask across a wide variety of disciplines in order to help ensure their clients receive optimal treatment. Nurse case managers tend to specialize in one of four areas:
Some RN case managers focus on working with a particular population demographic such as children or the elderly.
• Practice setting:
Some nurse case managers specialize in working in hospital settings while others may work in hospices, long-term care facilities, or home healthcare.
Registered nurse case managers can also focus on treatment duration. Some case managers may concentrate on short-term rehabilitation for injuries, for example, while others concentrate on long-term treatment for chronic conditions.
RN case managers can also provide management to clients affected by specific illnesses such as diabetes, cancer, AIDS, or mental illnesses.
Often, RN case managers work with patients whose needs are complex. Nurse case managers play an enormous role in helping to control the costs associated with providing treatment to such patients. They do so by eliminating treatment redundancies, reducing the utilization of expensive emergency interventions
, and facilitating communication with insurance providers.
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WHERE DOES A REGISTERED NURSE CASE MANAGER WORK?
Nearly 110,000 nurse case managers are employed in various practice settings throughout the U.S
. They’re often employed by hospitals in acute care settings such as intensive care units (ICUs), neonatal intensive care units (NICUs), burn units, and trauma units. But registered nurse case managers also work in:
• Medical centers:
Medical centers employ RN case managers to do utilization review and discharge planning.
• Outpatient care centers:
In outpatient care settings, RN case managers may focus on partnering with insurance providers to ensure prompt payment of claims.
• Skilled nursing facilities:
In skilled nursing facilities and other long-term care settings, RN case managers are typically in charge of utilization review. They also help develop patient care plans and negotiate insurance coverage benefits.
In hospice settings, nurse case managers play a key role in coordinating care and in making sure care plans and other documentation meet Medicare and other insurance provider requirements.
• Community care agencies:
In community care settings, RN case managers often focus on preventative health. They may conduct screenings, helm wellness programs, and engage in client education campaigns.
• Insurance providers:
Nurse case managers who work for insurance providers review the data they receive from physicians, hospital case managers and ancillary healthcare providers to make sure policy beneficiaries are receiving high-quality, medically necessary treatment.
WHAT ARE THE TYPICAL WORKING HOURS OF A REGISTERED NURSE CASE MANAGER?
Since registered nurse case managers don’t perform clinical duties, for the most part they work standard 8-hour shifts, Mondays through Fridays, even when they’re employed by acute care hospitals. Some RN case managers who work out of their own homes may have more flexibility in their work hours.
WHAT ARE THE PERSONALITY TRAITS OF A SUCCESSFUL RN CASE MANAGER?
It takes time for RN case managers to learn all the skills they’ll need in order to be good at their jobs. That learning curve can be shortened considerably, however, if RN case managers possess some or all of the following personality traits:
Registered nurse case managers take responsibility for their own actions. As case managers, they’re charged with overseeing many aspects of their client's care, including patient education, therapeutic options and financial management, and it’s imperative that they assume ownership for their actions.
RN case managers must keep the trust. If they say they are going to do something, they must follow through on that promise.
A good case manager is a people person. RN case managers interact with many people over the course of their work, and those people will respond most positively when approached with spontaneous warmth and goodwill.
Basic consideration for others and generosity of spirit will make the RN case manager’s job much easier.
RN case managers need to have a pleasant manner so that their clients and colleagues find them easily approachable.
RN case managers need to be flexible because the availability of resources like transportation options or hospital beds can change instantly, and case managers will need to be able to locate alternative solutions quickly.
• Cultural sensitivity:
RN case managers must be comfortable interacting with clients and colleagues from a wide variety of ethnic and cultural backgrounds.
WHAT ARE THE KEY SKILLS NEEDED TO WORK AS A RN CASE MANAGER?
RN case managers deal with patient logistics, and as such, they need to be good at identifying resources and distribution networks, and understanding how resources are allocated within a specific healthcare delivery system. The skills needed to be a registered nurse case manager include:
RN nurse managers are often called upon to review the effectiveness of a program or specific intervention. In order to do this successfully, they must be able to research complex issues and evaluate data.
RN nurse managers must be able to identify issues related to patient treatment plans and revise those treatment plans quickly if that necessity arises.
• Time management:
RN case managers often juggle multiple clients simultaneously. They must understand how to prioritize their interactions with clients, facilities and organizations effectively to help ensure the continuous delivery of high-quality services. The ability to switch quickly from one task to another is highly prized.
RN case managers must have excellent verbal and written communication skills. An important part of their job involves facilitating the information flow between patients, care providers, medical facilities, and other stakeholders. Stakeholder education is a key part of their job description as well, and education depends upon the ability to communicate effectively.
• Conflict resolution:
Conflicts invariably arise from time to time in any situation where multiple stakeholders are involved. RN case managers must understand how to defuse potentially volatile situations so that even when consensus cannot be reached, partners can continue to work together in the best interests of patients.
RN case managers must be prepared to assume a leadership role in motivating partners to continue working toward the common goal of patient wellbeing.
HOW TO BECOME A REGISTERED NURSE CASE MANAGER?
What Education Is Required To Become A Registered Nurse Case Manager?
In order to become a registered nurse case manager, you must first become a registered nurse. That means, you’ll have to earn either an Associate Degree in Nursing
(ADN) or a Bachelor of Science in Nursing
(BSN). You’ll have to have a high school diploma to enter either of these two registered nursing tracks. Educational specialists recommend taking high school classes in algebra, geometry, biology, and chemistry to prepare yourself.
Two-year ADN programs are offered by online providers as well as by campus-based providers at community, technical and vocational colleges. Four-year BSN programs are also offered through online providers as well as by campus-based colleges and universities.
Some RNs choose to pursue advanced practice registered nurse
(APRN) studies after they’ve completed their basic nursing education. Two non-clinical APRN specialties are particularly relevant for prospective RN case managers: the nurse manager/administrator track and the nurse executive track. The truth is, however, that no matter what APRN concentration you pursue, you’ll be amply prepared to assume management responsibilities.
What Licensure Is Required To Become A Registered Nurse Case Manager?
The second step in becoming a registered nurse case manager involves passing the National Council Licensure Examination
(NCLEX-RN), which is administered by the National Council of State Boards of Nursing
. After you pass the NCLEX-RN exam, you’ll be eligible to apply for licensure through your state’s Board of Nursing.
NCLEX-RN is not your typical multiple-choice exam. It utilizes a technique called computerized adaptive testing in which artificial intelligence chooses the questions you answer based upon your responses to earlier questions. The five-hour exam contains anywhere between 75 and 145 questions, and costs $200. The score you receive on your NCLEX-RN exam is called a “logit,” which is a unit of measurement that compares your ability to answer questions to the difficulty of the questions. The passing logit score for the NCLEX-RN is zero.
Registered nurse licensure fees vary from state to state. You can hold a nursing license in multiple states.
What Certifications Are Required OR Recommended For A Registered Nurse Case Manager?
Increasingly, employers are looking for certification before they will employ you as a registered nurse case manager. Three certification routes are available to RN case managers:
• CCM certification:
This certification is offered through the Commission for Case Manager Certification
(CCMC.) It’s not RN-specific. In order to qualify to sit for the test, you must meet criteria in one of three categories, and that means you will have to have at least one year of full-time case management experience within the U.S. or a U.S. territory. The three-hour CCM exam consists of 180 multiple-choice questions. A passing score on the CCM is 70 percent or higher
. The exam application fee is $160, and the exam fee itself is $185.
• ACM certification:
The American Case Management (ACM) certification is offered by the American Case Management Association
. The certification is open to both registered nurses and social workers. In order to sit for the exam, you must have at least one year of experience as a care coordination RN. The exam fee is $349 if you want to use one of the quarterly testing dates or $395 if you want to test right away. The exam is a combination of simulations and multiple-choice questions. The ACM exam is a pass/fail test
This exam is administered by the American Nurses Credentialing Center and is recognized by the Accreditation Board for Specialty Nursing Certification
. To take this exam, you must have at least two years of full-time experience as a registered nurse and 2,000 clinical hours in nursing case management. The application fee is $270 for members of the American Nurses Association
members and $395 for non-members. The exam consists of 150 multiple-choice questions. The passing score on the ANCC certification exam is 350 or higher
A fourth certification, the CCCTM certification
, was discontinued in October 2020. It was sponsored by the American Academy of Ambulatory Care Nursing
, which is the professional association for med/surg nurses. Its content has been incorporated into the ANCC exam. While registered nurses will no longer be able to pursue this certification for the first time, previously certified nurses will be able to renew their certification.
What Additional Training And Experience Is Required To Become A Registered Nurse Case Manager?
Most employers prefer to hire someone with at least one year of RN case management experience. It’s kind of a Catch 22 situation: You won’t get hired unless you have experience, and you can’t get experience unless you’re hired. If you’re hoping to break into this field, take advantage of the networking connections you make by joining professional associations and build out your resume by taking relevant continuing education classes. Familiarity with utilization review, discharge planning and the coordination of services are the three most important competencies prospective employers are looking for when they hire RN case managers.
What Are The Continuing Education Requirements For A RN Case Manager?
Continuing education units (CEUs) are not a requirement at the state level for RN case management employment. They are a requirement for RN licensure renewal at the state level
, however. They’re also a requirement for renewal of all three of the top case management certifications: CCM recertification requires 80 CEUs every five years
; ACM recertification requires 40 CEUs every four years
; AACN recertification requires 75 CEUs every three years
TIME & COST ASSOCIATED WITH BECOMING A REGISTERED NURSE CASE MANAGER
How Long Does It Take To Become A RN Case Manager?
Becoming an RN case manager generally takes between three and one-half and five and one-half years. It will take you two years to complete an ADN and four years to complete a BSN. Allocate another six months to studying for and passing your NCLEX-RN exam. Most employers prefer to hire experienced RNs into case management positions, so add at least one more year.
How Much Does It Cost To Become A RN Case Manager?
The primary costs of becoming a registered nurse case manager are those associated with your nursing education, your NCLEX-RN exam, and obtaining your nursing license. A two-year ADN program will set you back anywhere between $10,000 and $40,000; a BSN program will set you back between $40,000 and $100,000. Registering for the NCLEX-RN examination costs $200. RN licensure fees vary from state to state
CAREER ADVANCEMENT OPPORTUNITIES FOR REGISTERED NURSE CASE MANAGERS
RN case management doesn’t have a well-defined career trajectory. In fact, case management itself is often considered a type of career advancement opportunity for registered nurses.
Certification, in particular, can be a valuable career-building strategy. Most commonly, RN case managers advance their careers by specializing in a specific disease area such as diabetes, congestive heart failure, or management of multiple symptoms
. Other RN case managers go on to become nurse navigators, helping patients maneuver the ins and outs of the healthcare system and working with insurance plans to get the services they need covered. Oncology is an area where patients particularly benefit from working with a nurse navigator because oncology patients have such complex needs.
WHAT ARE THE TOP CONS OF BEING A REGISTERED NURSE CASE MANAGER?
There are good things and bad things about becoming an RN case manager. Here are the top cons of being a registered nurse case manager:
Patients who need a case manager are typically patients with complex diagnoses or life circumstances that require an extra amount of attention from you and other healthcare professionals. Often, the amount of work involved in scheduling and following up on the interventions such patients require can seem overwhelming.
2. Bearer of bad news:
You’re often the healthcare team member who has to break bad news to a patient or a family member when your patient’s insurance won’t cover a particular intervention.
There’s an enormous amount of paperwork involved in being an RN case manager. If you actively dislike filling out forms, this is not the right career track for you.
4. Difficult clients:
Patients with chronic health conditions are likely to make up a huge portion of your client base. These patients can be very difficult to work with. This is one of the biggest disadvantages of being an RN case manager.
5. Compassion fatigue:
RN case managers deal primarily with long-term patients. Like other healthcare professionals, RN nurse case managers can be prone to compassion fatigue.
6. Comparatively low salary:
On the whole, RN nurse managers make lower salaries than clinical nurses.
WHAT ARE THE TOP PROS OF BEING A REGISTERED NURSE CASE MANAGER?
The decision to become a registered nurse case manager can also be the source of enormous job satisfaction. Here are the top pros of being a registered nurse case manager:
1. Multiple practice settings:
As a RN case manager, you’ll develop skills that will allow you to seek employment in many different practice settings, including hospitals, outpatient clinics, ambulatory care centers, insurance providers, and community health agencies.
2. Regular work hours:
RN case managers typically work standard 9-to-5 business hours. When you become an RN case manager, you won’t have to work evenings, nights, weekends or holidays as so many other registered nurses have to do. This may be one of the biggest advantages of being an RN case manager.
3. Multidisciplinary work team:
Since case management is a collaborative process, RN case managers have the opportunity to work with a wide spectrum of healthcare professionals, including physicians, staff nurses, social workers, and ancillary medical professionals.
4. Physically undemanding:
Bedside nursing is a physically demanding job. As a result, registered nurses have much higher rates of back, neck, shoulder, and knee problems than most other occupational groups
. Most of the work you do as an RN case manager, however, is done from your desk. You just have to remember to get up and stretch every now and then.
5. Close connections:
RN case managers frequently follow the same set of clients over a long period of time. They have the opportunity to form deep bonds with their patients, and this can be very gratifying.
6. Job satisfaction:
Helping a needy client navigate his or her way successfully through the complex and often overwhelming healthcare system can be a source of great personal satisfaction.
REGISTERED NURSE CASE MANAGER SALARY + BENEFITS
What Is The Starting Salary Of A Registered Nurse Case Manager?
The starting salary of a registered nurse case manager is $26.72 an hour, $4,630 a month or $55,570 a year, which is 31 percent less than the average salary for a registered nurse case manager. Training an RN case manager can be an expensive proposition, and lower entry-level salaries are likely a strategy that allows employers to recoup some of those training costs.
What Is The Average Salary Of A Registered Nurse Case Manager?
The average salary of a registered nurse case manager is $38.82 an hour, $6,730 a month, or $80,754 a year. This is 1 percent higher than the average registered nurse salary throughout all specialties ($90,901
.) RN case managers usually achieve this milestone during the 10th year of their career. Nurse case managers with a master’s degree typically earn salaries that are 19 percent higher than nurse case managers with BSN degrees
. For the most part, RN case managers are salaried employees, which means they are not covered by the Fair Labor Standards Act
and do not earn overtime if they work more than 40 hours in a week.
How Much Does The Registered Nurse Case Manager Salary Grow With Experience?
On average, nurse case managers with one to four years of experience earn salaries that are 8 percent higher than entry-level nurse case managers while nurse case managers with five to nine years of experience earn salaries that are 33 percent higher than entry-level nurse case managers. RN case managers with two decades or more of experience make salaries that are 65 percent higher than the average RN case manager salary.
| Level of Experience || Annual || Monthly || Hourly |
| Entry-Level || $55,570 || $4,630 || $26.72 |
| 1-4 Years of Experience || $60,500 || $5,040 || $29.09 |
| 5-9 Years of Experience || $73,690 || $6,140 || $35.43 |
| 10-19 Years of Experience || $91,720 || $7,640 || $44.10 |
| 20 Years or More Experience || $117,400 || $9,780 || $56.44 |
What Benefits And Perks Can A Registered Nurse Case Manager Expect?
Employee benefits are non-cash compensation over and above salaries. In addition to legally mandated benefits such as COBRA, workers’ compensation and unemployment insurance, RN case managers can expect to receive:
• Healthcare insurance:
This can include vision and dental insurance in addition to medical insurance at an individual employer’s discretion.
• Paid time off:
In addition to holidays, RN case managers can also accrue vacation days and sick leave.
• Retirement contributions:
Employers will often match contributions RN case managers make to company-sponsored 401(k) plans.
• Mileage reimbursement:
Home healthcare RN case managers and other RN case managers who routinely drive as a condition of employment may be reimbursed for the distances they drive.
AVERAGE SALARY OF A REGISTERED NURSE CASE MANAGER IN YOUR STATE
RN case manager salaries show an enormous degree of variation from state to state. Salaries are highest in the western states and along the northeastern seaboard, and lowest along the southeastern seaboard and in the Midwest. California is the state where RN case managers earn their highest salaries, and Arkansas is the state where RN case managers earn the lowest salaries. A California-based RN case manager earns more than twice as much as an Arkansas-based RN case manager.
| State || Hourly || Monthly || Annual |
| Alabama || $29.18 || $5,060 || $60,700 |
| Alaska || $45.06 || $7,810 || $93,730 |
| Arizona || $37.83 || $6,560 || $78,690 |
| Arkansas || $29.02 || $5,030 || $60,360 |
| California || $58.16 || $10,080 || $120,970 |
| Colorado || $37.77 || $6,550 || $78,560 |
| Connecticut || $41.12 || $7,130 || $85,520 |
| Delaware || $37.08 || $6,430 || $77,130 |
| Florida || $34.86 || $6,040 || $72,500 |
| Georgia || $37.15 || $6,440 || $77,280 |
| Hawaii || $49.38 || $8,560 || $102,720 |
| Idaho || $34.29 || $5,940 || $71,320 |
| Illinois || $35.86 || $6,220 || $74,590 |
| Indiana || $32.97 || $5,710 || $68,570 |
| Iowa || $30.26 || $5,250 || $62,940 |
| Kansas || $31.40 || $5,440 || $65,310 |
| Kentucky || $33.86 || $5,870 || $70,420 |
| Louisiana || $33.12 || $5,740 || $68,880 |
| Maine || $33.76 || $5,850 || $70,230 |
| Maryland || $38.38 || $6,650 || $79,830 |
| Massachusetts || $45.43 || $7,870 || $94,490 |
| Michigan || $35.18 || $6,100 || $73,180 |
| Minnesota || $38.76 || $6,720 || $80,620 |
| Mississippi || $29.63 || $5,140 || $61,630 |
| Missouri || $31.34 || $5,430 || $65,190 |
| Montana || $34.17 || $5,920 || $71,080 |
| Nebraska || $32.06 || $5,560 || $66,690 |
| Nevada || $42.01 || $7,280 || $87,380 |
| New Hampshire || $36.38 || $6,310 || $75,680 |
| New Jersey || $42.16 || $7,310 || $87,700 |
| New Mexico || $37.33 || $6,470 || $77,640 |
| New York || $43.67 || $7,570 || $90,840 |
| North Carolina || $33.77 || $5,850 || $70,240 |
| North Dakota || $32.71 || $5,670 || $68,040 |
| Ohio || $34.22 || $5,930 || $71,170 |
| Oklahoma || $33.55 || $5,820 || $69,790 |
| Oregon || $46.50 || $8,060 || $96,720 |
| Pennsylvania || $35.17 || $6,100 || $73,150 |
| Rhode Island || $38.49 || $6,670 || $80,060 |
| South Carolina || $32.42 || $5,620 || $67,440 |
| South Dakota || $28.13 || $4,880 || $58,520 |
| Tennessee || $31.62 || $5,480 || $65,760 |
| Texas || $36.78 || $6,380 || $76,500 |
| Utah || $33.32 || $5,780 || $69,310 |
| Vermont || $34.89 || $6,050 || $72,570 |
| Virginia || $35.71 || $6,190 || $74,270 |
| Washington || $44.35 || $7,690 || $92,240 |
| West Virginia || $31.50 || $5,460 || $65,530 |
| Wisconsin || $35.33 || $6,120 || $73,490 |
| Wyoming || $35.34 || $6,130 || $73,500 |
HIGHEST PAID REGISTERED NURSE CASE MANAGERS
What Are The 10 Highest Paying States For RN Case Managers?
Registered nurse case managers in California earn $120,970 annually, which makes California the highest-paying state so far as RN case manager salary is concerned. Regional variations in salary tend to reflect differences in the cost of living from place to place. California
are the two states with the highest cost of living indices. If the average RN case manager salary wasn’t high in those two states, the demand for RN case management services might not be met because RN case managers might not be able to afford to live there.
| Rank || State || Average |
| 1 || California || $120,970 |
| 2 || Hawaii || $102,720 |
| 3 || Oregon || $96,720 |
| 4 || Massachusetts || $94,490 |
| 5 || Alaska || $93,730 |
| 6 || Washington || $92,240 |
| 7 || New York || $90,840 |
| 8 || New Jersey || $87,700 |
| 9 || Nevada || $87,380 |
| 10 || Connecticut || $85,520 |
What Are The 10 Highest Paying Metros For RN Case Managers?
All 10 of the cities where RN case managers earn their highest salaries are in California. Cost of living variations are also the most likely explanation for the reason why RN case manager salaries in Chico are 23 percent lower than they are in the crowded San Francisco Bay Area.
| Rank || Metro || Average |
| 1 || San Francisco-Oakland-Hayward, CA || $149,480 |
| 2 || San Jose-Sunnyvale-Santa Clara, CA || $145,180 |
| 3 || Vallejo-Fairfield, CA || $143,650 |
| 4 || Santa Rosa, CA || $137,130 |
| 5 || Santa Cruz-Watsonville, CA || $135,860 |
| 6 || Napa, CA || $132,820 |
| 7 || Sacramento--Roseville--Arden-Arcade, CA || $131,760 |
| 8 || Modesto, CA || $125,660 |
| 9 || Stockton-Lodi, CA || $118,280 |
| 10 || Chico, CA || $114,690 |
REGISTERED NURSE CASE MANAGER JOB OUTLOOK
Is There A Demand For RN Case Managers?
There is no shortage of nurses looking for a way out of clinical nursing for whom RN case management represents an attractive option. As such, competition for available RN case management jobs can be stiff. So, while there is certainly a demand for RN case managers, for the most part, that demand is being met.
Why Is There A Demand For RN Case Managers?
The case management model first gained notice in the 1990s
as a means of handling the escalating costs associated with healthcare delivery in the U.S. That concern with costs continues to be a major driver in the U.S. healthcare industry, so there continue to be many employment listings for RN case managers. The Bureau of Labor Statistics projects that the demand for medical and health services managers will grow by 32 percent between 2020 and 2030
. Note, however, that RN case managers are not “managers’ in the traditional sense of the word. It would be more accurate to call them “case facilitators.”
MOST COMMON INTERVIEW QUESTIONS AND ANSWERS FOR RN CASE MANAGER JOBS
The following are examples of registered nurse case manager interview questions you may be asked when you’re applying for a staff position as an RN case manager.
Question #1: How do you manage a heavy case management workload?
What the Interviewer Really wants to Know: The interviewer wants to learn about your organizational and time management skills, particularly the skills you use to prioritize multiple tasks with specific deadlines. The interviewer is also interested in how you protect yourself against burnout.
Sample Answer: I make a lot of lists! I have a system in place that quickly allows me to prioritize tasks assigned to me in terms of importance, urgency and external constraints (for example: Medicare application deadlines.) This allows me to justify my decisions if they’re ever called into question. I try to tackle the most difficult tasks early in the day when I’m feeling freshest. (Obviously, this doesn’t work for client appointments, and scheduled meetings or phone calls.) If I need to talk strategy, I bounce things off my colleagues and supervisor. If I feel myself becoming overwhelmed, I try to think of some way I can delegate tasks.
Question #2: How do you establish rapport with the families of your clients?
What the Interviewer Really wants to Know: This interview question is designed to probe the depth of your interpersonal skills.
Sample Answer: I always treat family members and their loved ones with dignity and respect. From the start, I try to establish trust with the family. That means I go out of my way to keep communication lines open, and I strive to be accountable. If I tell a family I’m going to do something, then I do it; if I have the slightest bit of doubt about whether I can accomplish something, then I don’t promise it. I practice active listening. I try to stay positive but honest. If family members have unrealistic expectations, I do gentle reality-testing with them.
Question #3: How do you evaluate the care your patients may have received from other professionals on your case management team?
What the Interviewer Really wants to Know: This question gets to the heart of your ability to be a team player, which is an essential requirement of any RN case management position.
Sample Answer: I understand that a good deal of time when a client complains about a member of the healthcare team, he or she is venting, so I practice active listening. If a complaint comes up more than once, I do some follow-up. This may involve speaking informally with the other professional to get their side of the story or if my client is concerned about a specific incident, reading that other professional’s notes. I always prefer to rectify issues by speaking to colleagues informally if that’s an option. But if a situation is serious enough, I will go up the chain of command and get supervisors involved.
Question #4: Tell us about a time when you had to explain complex information to a client.
What the Interviewer Really wants to Know: This question tests your basic communication skills. RN case managers need to be good at simplifying medical information so that clients and their families can easily understand it.
Sample Answer: As a home healthcare RN case manager, I’ve had many patients who’ve been diagnosed with pneumonia. Some of them weren’t too sure what “pneumonia” actually was! I developed a set of diagrams of the bronchioles and alveoli within their lungs to illustrate that pneumonia is an infection of those alveoli (which I called “air sacs.”) This visual made it easier for my patients to understand why they were struggling to fill their lungs as well as the importance of the respiratory therapies that had been prescribed for them.
Question #5: Where do you see yourself in five years?
What the Interviewer Really wants to Know: This question is part of the standard arsenal of questions that are put to job applicants no matter what position they are applying for. It speaks to your commitment to case management as a career path as well as to your loyalty toward prospective employers.
Sample Answer: When I accept a new position, I make a commitment to stay at least three years because I understand that the training I receive represents a considerable investment on the part of my employer. Right now, I have a BSN in nursing. I am hoping to expand my education and knowledge base by enrolling in a master’s level degree program within the next two years that specializes in the types of skills valuable to a case manager. I should be able to continue working while I pursue my education.
USEFUL RESOURCES FOR REGISTERED NURSE CASE MANAGERS
Organizations And Associations
• American Case Management Association
(ACMA): ACMA is the premier professional organization for hospital case management professionals though membership in the organization is not restricted to registered nurses. The association sponsors the ACM certification and also offers educational forums, networking opportunities, and legislative advocacy. Dues are either $125 a year or your annual salary multiplied by 0.00175.
• Case Management Society of America
(CMSA): CMSA has more than 11,000 members and 75 chapters. It offers free CEUs, leadership programs and educational forums, and sponsors an annual conference in late February. Dues are $170 a year plus whatever the dues are imposed by your local chapter.
• Commission for Case Manager Certification
(CCMC): CCMC sponsors the best known of the three case management certification tracks. (A 2018 survey found that 60 percent of employers reimbursed for the CCMC exam
and that 44 percent of employers required that certification.) The organization has more than 44,000 members and offers CEUs, educational webinars, and podcasts.
• National Association of Case Management
(NACM): NACM represents case managers from a variety of professional backgrounds. It’s a nonprofit, and individual membership dues are $25 annually. It sponsors an annual conference over the Labor Day weekend, and also offers job listings and networking opportunities.
The popular online nursing community allnurses
has a forum that’s dedicated to case management
. RN case managers come here to talk about issues ranging from experiences working with specific insurance providers to help with workers’ compensation claims to organizational tips. This is an invaluable resource.
• Day in the Life of A Nurse RN Case Manager
: This six-and-a-half-minute video was produced by an RN case manager who works for a hospice. Although the video has a lot of extraneous information about the nurse’s personal life, it also presents a solid summary of what it’s like to be an RN case manager helping home-bound patients at the end of life.
• What Is a Case Manager Nurse?
: A four-minute review of the RN case manager’s professional responsibilities, certification options, and salary. This doesn’t really qualify as a video since the screen is fixed on a single slide throughout. Production values are low.
• The Nursing Channel
: The Nursing Channel, which has approximately 123,000 subscribers, has produced a series of YouTube videos that explore various aspects of RN case management. These videos have titles like What Is a Nurse Case Manager?
, How To Become an RN Case Manager
, and What Are the Downsides to Case Management? The channel’s case management series features an RN case manager called Sam who discusses this nursing career track in a thorough and candid manner. Highly recommended for anyone who’s interested in learning more about this nursing specialty.
• Take a Listen
: CCMC has produced a series of podcasts featuring short conversations with healthcare leaders on issues that impact the case management industry. You must be a CCMC member to access these podcasts.
• Care Transitions Today
: ACMA produces a podcast series hosted by Senior Vice President for Practice Development Deb McElroy. This series focuses on healthcare case management and transition of care throughout healthcare systems. Each podcast is approximately 45 minutes long. You can listen to these podcasts even if you aren’t an ACMA member.
• Let's Talk About Nurse Case Management
: In this bonus episode of the ongoing Nurse Keith Show podcast, Nurse Keith interviews Deanna Gillingham, the CEO of the Case Management Institute. The podcast is 38 minutes long and is carried by the Apple podcast network.
• Case Management: A Practical Guide for Education and Practice
: This book is a thorough review of the many hats an RN case manager must wear in the course of his or her work. It relies upon experiential, problem-based learning models and includes information on current practice issues, including the many different ways in which the Affordable Care Act has impacted case management. It also contains a large amount of past CCMC exam info, making it an ideal prep for any upcoming CCMC test.
• A Guide for Nurse Case Managers
: This book is specifically geared toward RN case managers who are just starting out their careers in hospital and clinic settings. It’s particularly strong on the care planning process, the basics of utilization review, and the impact of Medicare and Medicaid protocols.
BONUS! A TYPICAL DAY IN THE LIFE OF A RN CASE MANAGER
The responsibilities of a registered nurse case manager will vary considerably depending upon the practice setting in which he or she is employed. Here, we’ll talk to Danielle who’s an RN case manager for a company that operates three hospice facilities:
9:00 a.m. – 10:00 a.m.:
I split my weeks between working from home and working from the office I maintain at one of the hospice facilities. On days I come in to the office, I grab a cup of coffee and then boot up my computer so that I can review any emails that have accumulated since work ended the evening before.
This morning, I’ve received three emails regarding a thorny reimbursement issue with a resident at one of our hospice facilities. Two were from frantic relatives; the other was from the director of the facility.
I answer the relatives’ emails first, reassuring them that the issue will soon be resolved. Then I write to the hospice director. In addition to Medicare, the patient we’re corresponding about also carries supplemental insurance, and it seems the reimbursement issue is primarily due to miscommunication between Medicare and the supplemental insurance provider.
I take a few moments to review the pertinent Medicare guidelines before calling the supplemental insurance provider. I’m on hold for 15 minutes before I finally connect with the RN case manager on the insurance provider’s end, but once I do so, the issue is easily talked through. Once his superiors sign off, the insurance provider’s RN case manager tells me, the proper reimbursement will be on its way.
10:00 a.m. – 11:00 a.m.:
I visit two clients who are residents of the hospice where my office is. At any given time, my caseload is between 12 and 18 clients, but I seldom interact with more than three or four on the same day. The majority of clients that my hospice company serves actually prefer to receive hospice services in their own homes, so often, my day consists of a lot of driving. Not today, though.
Joseph, the first client I visit, is up and sitting in a chair by the window speaking lucidly with members of his family. His wife signals me that she wants to talk with me outside the room. “He seems so good,” she tells me. “Are his doctors positive that he needs hospice care? What should I be expecting?”
I make a note to have Joseph’s oncologist call her.
Christina, the second client I visit, is lying in bed. When I ask her how she is, she replies, “Everything hurts.” I make a note to review her analgesia schedule and to consult with her oncologist about analgesia that may be more effective.
When I get back to my office, I make those phone calls.
11:00 a.m. – 1:30 p.m.:
During our weekly interdisciplinary staff meeting with representatives from all three hospices, we review the status of all our clients. Nurses are particularly concerned about one elderly client who is being cared for in his own home and whose sole care provider is his elderly wife. “She is exhausted,” observes one nurse. Medicare provides reimbursement for respite caregivers under certain circumstances, so when I get back to my office, I make a phone call to set that up.
1:30 p.m. – 2:00 p.m.:
Lunchtime! I make a point of taking my lunch break even when I’m very busy. When you become an RN case manager, you’re taking on a very intense job, and I want to avoid burnout.
2:00 p.m. – 3:30 p.m.:
I lead an in-service on the development of hospice-related nursing care plans for nurses from all three facilities. Some of these nurses have come in on their day off. We cover the basics of medication, other palliative treatments, diet, and exercise. While I’m the person who actually signs off on all nursing care plans, team-building exercises like these underscore the importance of an organized approach to care.
3:30 p.m. – 5:00 p.m.:
A new client is being admitted into the hospice facility. We’ve been caring for Jack in his home for the past six weeks, but he has recently become much more debilitated, and his family has made the difficult decision to transfer him here. We settle Jack into his new room, and then give his wife and adult children a tour of the facilities and a description of the services that are available to Jack here. Jack’s family is feeling conflicted about their decision; we try to reassure them.
5:00 p.m. – 6:00 p.m.:
I make a few more phone calls and review the emails that have come in over the course of the day. I organize my schedule for the next few days so that when I’m working from home tomorrow, I can hit the ground running. I try to leave by 6:00 p.m. at the latest even if that means I leave work unfinished because if I don’t, I’ll be entering burnout territory.
My Final Thoughts
This article has presented a comprehensive examination of the career track of a registered nurse case manager – what is it, how to become, salary, and the pros & cons. Very often, the registered nurse case manager position functions as a “step-away” option for nurses who want to take a break from the hectic pace of clinical nursing. But it can be a satisfying career opportunity in and of itself for a nurse with outstanding organizational skills who sees patient care as a continuum that goes beyond one-on-one bedside nursing.
FREQUENTLY ASKED QUESTIONS ANSWERED BY OUR EXPERT
1. Is Becoming an RN Case Manager A Good Career Choice?
Becoming an RN case manager can be a great career choice for someone who has strong executive skills and is looking for a way to transition out of bedside nursing. If you aren’t highly organized by nature, though, this may not be the career path for you.
2. Is It Hard To Become A Registered Nurse Case Manager?
If you have no experience in the field, getting hired as a registered nurse case manager can be a challenge. Taking continuing education classes is sometimes a good way to get your foot in the door. Once you have one year of employment under your belt, you probably won’t have any problems finding other RN case manager work.
3. Is Nurse Case Management Stressful?
Nurse case management can be stressful, but it’s a different type of stress than the stress that’s associated with clinical nursing. With clinical nursing, you can feel emotionally overwhelmed; with RN case management, you are more likely to feel overwhelmed by paperwork.
4. Do Nurse Case Managers Make Good Money?
Nurse case managers are among the lowest earners on the registered nurse pay scale. However, they do work far more regular hours and have their weekends to themselves. Most RN case managers also find case management considerably less stressful than bedside nursing.
5. What Is The Difference Between An RN Care Manager And RN Case Manager?
Often, the terms “RN care manager” and “RN case manager” are used interchangeably. But they actually have very different meanings. RN care managers focus on the needs of individual patients while RN case managers follow patients with whatever specific conditions the RN case manager specializes in.
6. On Average, How Much Does A Registered Nurse Case Manager Make Per Hour?
On average, RN case managers earn $38.82 an hour. Most RN case managers are salaried employees rather than wage earners, however, which means they get a biweekly or monthly paycheck in the same amount no matter how many hours they work.
7. Do RN Case Managers Make More Than Floor Nurses?
RN case managers actually earn slightly less than floor nurses. This may be because RN case managers are salaried employees, so they don’t have the opportunity to earn shift differentials or overtime pay when they work over 40 hours a week the way that floor nurses do.
8. In Which Settings Do Nurse Case Managers Earn The Most?
Location affects earning potential. RN case managers tend to earn their highest salaries in the insurance industry and working in hospitals, and their lowest salaries working in long-term care facilities.
9. Do I Need To Be An RN To Be A Case Manager?
You don’t have to be a registered nurse to become a case manager. Many social workers are employed as case managers. However, in order to become an RN case manager, you must be a registered nurse. You cannot be employed as an RN case manager if you are a licensed practical nurse (LPN) or a licensed vocational nurse (LVN.)
10. Can I Become A Nurse Case Manager With No Experience?
It can be challenging to become a nurse case manager without experience as most employers prefer to hire professionals with one or two years of practice under their belts. Take continuing education classes in the field, and seek out discharge planning or utilization review opportunities at your present job. Emphasize those experiences when you are interviewing for an RN case management position.
11. What Does An RN Case Manager Do In Home Health?
RN case managers in the home healthcare field develop nursing care plans, working closely with the RNs who are actually going into homes to provide treatment. Case managers meet with patients and family members to discuss those treatment plans and their expected outcomes. RN case managers also interact with Medicare representatives, Medicaid representatives, representatives of insurance carriers and other payment providers to help ensure treatments and medications are cost-effective.
12. What Is The Role Of A Nurse Case Manager In An Emergency Room?
In emergency room settings, case managers are responsible for facilitating a patient’s experience from preadmission through discharge from the Emergency Department. This may involve interfacing with insurance carriers and government providers like Medicare as well as interacting with physicians, clinical nurses, social workers, and other healthcare professionals.
13. As a Case Management Nurse, Can I Work From Home?
Some RN case managers work from home. Remote RN case managers, as they are called, are most often employed by insurance providers. Another type of home-based RN case manager is the telephonic triage nurse who determines the level of care a specific patient may need by speaking to that patient or to the patient’s family members over the phone.
14. What Exactly Does A Work-From-Home Case Management Nurse Do?
Remote RN case managers have the same responsibilities that other RN case managers have except that their operations center is in their own home. They review treatment options, develop care plans, coordinate inpatient and outpatient care with physicians and other medical professionals, and communicate with families and patients just as hospital-based RN case managers do. Their focus centers on triage, however, so they’re more likely to work with patients in need of acute interventions rather than with patients who have chronic conditions.
Pattie Trumble, MPP, MPH
Pattie Trumble is a nurse who worked in both California and New York for many years as an emergency room nurse. She holds a Bachelor’s Degree in Economics from the University of California, Berkeley, and an Associate Degree in Nursing from the Samuel Merritt Hospital School of Nursing. After 10 years of providing direct care, she went back to school and earned concurrent Master’s degrees in both public policy and public health from the University of California, Berkeley. Thereafter, she worked for various public health agencies in California at both the community and state levels providing economic and legislative analysis.