Case management: Nursing

Case management is a collaborative process that involves assessing, planning, and coordinating care to meet the evolving needs of patients and their families. The goals of case management vary depending on the health care setting and patient needs but generally aim to develop a patient-centered plan of care by helping patients manage their healthcare needs, navigate the healthcare system, and achieve positive health outcomes. As a nurse in case management, you'll identify patient needs and use available resources to organize and coordinate patient-centered and cost-effective care.

Nurses in case management, often called case managers, have traditionally worked in public health, mental health, and long-term care settings, but also provide services in places like ambulatory clinics, assisted living communities, primary care offices, and acute care settings.

Case managers receive training and certification to perform specialized skills and functions involving care management, care coordination, and utilization review.

Care management is a strategy used to improve the health of specific groups of people by organizing services, avoiding duplication of care, and encouraging self-management of disease to lower health risks and reduce healthcare costs.

To do so, case managers identify patients and populations with modifiable health risks, tailor services and education to meet their needs, and ensure the right health professionals are able and available to provide care.

For instance, a case manager in a cardiology clinic will review electronic health records and identify patients who have been hospitalized more than once in the past year for exacerbations of heart failure. Understanding that these patients are more likely to develop complications and be readmitted to the hospital, the case manager creates a protocol to reduce the likelihood of symptom exacerbation.

On a regular basis, the case manager performs telephone check-ins with at-risk patients, asks them about their symptoms and barriers to disease management, while assessing their need for additional services. Depending on the patient’s needs, the case manager will schedule an appointment with the cardiology provider or coordinate care from another health care team member.

Care coordination is also a key part of the care management process, and involves organizing patient care activities, staff, and resources, and ensuring there’s effective communication between all members of the care team and the patient. For example, patients with complex health care needs can have difficulty navigating the care provided by various providers at different settings, where communication between providers can be inefficient.