How to Become an RN Case Manager


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    An RN Case Manager, also known as a care coordinator, specializes in the organization and collaboration of patient care and treatment by all members of the care team. Often, patients will be managed by multiple specialties and there will be numerous doctors involved. The case manager will ensure all of them are working as a team to provide the best care for the patient. In this guide, we'll cover everything you need to know about what a case manager is, what they do, and how you can become one.

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    FAQs

    • What is an RN Case Manager?

      • A case manager is a specialized RN that works with patients, usually with chronic health conditions, to coordinate their care during hospitalizations, outpatient appointments, and home care. 
    • What is the Average Salary of a Case Manager?

      • According to payscale.com, the annual salary for an RN case manager as of April 2020 is $72,017 per year or roughly $34.16 per hour.
    • What are the Five Components of Case Management?

      • Care Delivery and Reimbursement Methods
      • Psychosocial Concepts and Support Systems
      • Quality and Outcomes Evaluation and Measurements
      • Rehabilitation Concepts and Strategies
      • Ethical, Legal, and Practice Standards
    • What Qualities Should a Case Manager Possess?

      • Strong time management skills
      • Organization
      • Effective communication skills
      • Decision-making and problem-solving abilities
      • Autonomy
      • Teamwork
      • Creative personality
      • Strong clinical skills
      • Confidence

    Part One What is an RN Case Manager?

    A case manager is a specialized Registered Nurse (RN) that works with patients and providers to determine the specific care that is required and the best options for that care. Through a collaboration with multiple specialties, case managers ensure the patient is receiving quality medical care.

    Each patient’s case is looked at individually because the needs of the patients will vary depending on their underlying chronic health condition. Case Managers act as patient advocates and make sure the needs of the patient are met effectively and efficiently.

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    Part Two RN Case Manager Nurse Salary

    According to payscale.com, the annual salary for an RN case manager as of April 2020 is $72,017 per year or roughly $34.16 per hour.

    Case Manager Pay by Levels of Experience

    Payscale.com indicates the following pay by experience level for care managers:

    • Less than 1 year of experience can expect to earn an average of $65,490
    • 1 to 4 years of experience earns an average total compensation of $67,413
    • 5 to 9 years of experience earns an average total compensation of $71,301
    • 10 to 19 years of experience earns an average total compensation of $74,278
    • 20 years and higher experience employees earn an average total compensation of $76,570

    Highest Paying Cities for Case Managers

    Case managers have reported the highest salaries in the following locations as of April 2020,

    • New York, New York - $90,807
    • Los Angeles, California - $86,451
    • Houston, Texas - $80,774
    • Chicago, Illinois - $78,085
    • Atlanta, Georgia - $76,913
    • Philadelphia, Pennsylvania - $76,664

    Case Managers are generally salary-based employees. While some healthcare systems will pay an hourly rate, this is rare for this position. Those paid on an hourly scale are able to earn overtime pay whereas salaried employees would need to discuss that with the hiring committee.

    As with all jobs in the nursing field, earning potential increases with additional education and experience. Nurses typically are awarded a raise during annual employee performance reviews. Certifications can give nurses an additional bump in their paycheck. 

    Due to the fact this is a salary-based position, the earning potential is not as high as a bedside nurse. There are fewer opportunities outside of annual performance evaluation raises and cost of living increases.

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    Part Three How to Become an RN Case Manager

    Step 1: Graduate from an Accredited Nursing Program

    The first step to becoming an RN case manager is becoming a registered nurse. To do that, you’ll need to start by earning either your ADN or your BSN from an accredited nursing program.

    Step 2: Pass the NCLEX-RN

    Next, you’ll need to take and pass the NCLEX-RN examination in order to become a Registered Nurse.

    Step 3: Gain Nursing Experience

    In order to get the skills and qualifications you’ll need as an RN case manager, you’ll need to get at least 5 years of nursing experience under your belt. 

    Step 4: Get a Position that Specializes in Case Management

    While you’re earning your experience, you’ll also want to obtain a position that specializes in case management. 

    Step 5: Earn Your Certification in Case Management

    There a multiple-options for certification for Case Managers. See below for more information about each certification option.

    1.) The Commission for Case Manager Certification (CCMC) 

    The Commission for Case Manager Certification (CCMC) offers advanced certification to case managers that meet the eligibility requirements.

    In order to be eligible to sit for the exam, individuals must meet the following criteria:

    • Category 1: 12 months of acceptable full-time case management employment experience supervised by a board-certified case manager who has been certified for at least 12 months. Supervision is defined as the systematic and periodic evaluation of the quality of the delivery of the applicant’s case management services. OR
    • Category 2: 24 months of acceptable full-time case management employment experience. (Supervision by a CCM is not required under this category). OR
    • Category 3: 12 months of acceptable full-time case management employment experience as a supervisor of individuals who provide case management services. Acceptable employment experience MUST meet the following conditions:
      • At least 20% of qualified work time must focus primarily on case management practice.
      • Perform at least four of The Five Core Components of Case Management. Within each of the four of the five core components, you must:
      • Perform all Eight Essential Activities with Direct Client Contact
      • Provide services across a continuum of care, beyond a single episode of care that addresses the ongoing needs of the individual being served.
      • Be responsible for interacting with other relevant parties within the client’s healthcare system.
    • Your qualifying case management experience MUST be obtained in the United States, Puerto Rico, or the US territories.
    • Internship, preceptor-ship, practicum, and volunteer activities are NOT acceptable employment experience. 

    Other important notes about the certification examination include:

    • A current, unencumbered U.S. RN or APRN license is required. An unencumbered license is not currently being subjected to formal discipline by any state board of nursing and has no provisions or conditions that limit the nurse’s practice in any way.
    •  All hours must be verified by a supervisor
    • Computerized examination
    • Offered three times a year
    • Individuals are given an authorization to test number to schedule the examination
    • 3-hour time limit
    • Application & Examination Fee: $395

    CCM renewal eligibility requirements include:

    • There are two renewal options:
      • Option 1: Documentation of 80 clock hours of approved continuing education
      • Option 2: Re-examination
    • A current, unencumbered U.S. RN or APRN license is required. An unencumbered license is not currently being subjected to formal discipline by any state board of nursing and has no provisions or conditions that limit the nurse’s practice in any way.
    • Eight of the total eighty CEs required for renewal need to be ethics-related
    • To qualify for approval as continuing education, a program must meet the following criteria:
      • It must be at least one hour long.
      • It must be held in an accessible, barrier-free location so that no individual with a disability would be excluded from taking part. (Reference: Section 504, Rehabilitation Act of 1973 as needed).
      • It must include an evaluation by the participants to assess its effectiveness.
      • The purpose of the program must be clearly defined in terms of its objectives or expected outcomes.
      • It must be designed to increase the participant’s knowledge or skill regarding the practice of case management in one or more of the focus areas listed in this guide.
      • It must fall within your current 5-year renewal period.

    2.) ANCC Nurse Case Manager Certification (RN-BC)

    Another certification available for RN Case Managers is the ANCC Nurse Case Manager Certification (RN-BC).

    To be eligible to sit for the RN-BC exam, nurses must meet the following criteria:

    • Hold a current, active RN license in a state or territory of the United States or hold the professional, legally recognized equivalent in another country.
    • Have practiced the equivalent of 2 years full-time as a registered nurse.
    • Have a minimum of 2,000 hours of clinical practice in nursing case management within the last 3 years.
    • Have completed 30 hours of continuing education in nursing case management within the last 3 years.

    The cost for the exam is $395 and the exam allows 3 hours to answer 150 questions (125 scored plus 25 pretest questions that are not scored)

    The exam breakdown is as follows:

    Category Content Domain Number of Questions Percentage
    I Professional Foundation 25 20%
    II Care Coordination 37 30%
    III Quality Management 38 30%
    IV Health Promotion 25 20%

    3.)  American Case Management (ACM) Certification

    The American Case Management Association (ACMA) offers the American Case Management (ACM) certification to qualified individuals. According to the ACMA, this certification is unique among Case Management certifications because the examination:

    • Specifically addresses Case Management in health delivery system settings
    • Tests core Case Management knowledge that is shared by Nurse and Social Work Case Managers, as well as competency in the individual skills of each professional background
    • Utilizes clinical simulation testing methodology to test “competency beyond knowledge” – testing critical thinking skills and the ability to use knowledge in practical situations.

    To be eligible to apply for the certification examination, nurses must meet the following eligibility criteria:

    • A Registered Nurse (RN) applicant must possess a valid and current nursing license that is in good standing. RN applicants must provide a nursing license number, state and expiration date.
    • All applicants must have at least one (1) year**, or 2,080 hours, of supervised, paid work experience employed as a case manager, or in a role that falls within the Scope of Services and Standards of Practice of a case manager, by a Health Delivery System.
    • **Candidates with less than two (2) years of experience must provide supervisor contact information and an attestation that they have at least one (1) year of supervised case management experience on the ACM application. The NBCM recognizes that because case management experience, supervision and education vary, some case managers may be qualified to sit for the exam after only one (1) year of experience.

    This examination is offered four times a year and is $349. The ACM certification is valid for 4 years and 40 hours of CEUs are required for recertification. Specific recertification requirements include:

    • 30 of the 40 hours must be specific to the health care delivery system case management in your field of practice. The remaining ten 10 hours can be non-case management related.
    • 10 hours of non-case management specific continuing education must be related to the practice of healthcare in the certificate's field of practice.

    4.) Certification in Care Coordination and Transition Management (CCCTM)

    The last certification option for Case Managers is through the Medical-surgical nursing certification board. The Certification in Care Coordination and Transition Management (CCCTM) is a newer certification but is a credible option for interested individuals. Eligibility requirements include the following:

    • RN with a current license in the United States or territories
    • and Practiced 2 years as an RN in a Care Coordination and Transition Management role
    • and Accrued 2,000 hours of Care Coordination and/or Transition Management practice within the last 3 years as a registered nurse (RN)

    The exam is a computerized based testing exam format and costs $375. Additional information includes,

    • 150 multiple-choice questions. 120 scored and 30 unscored experimental questions.
    • Three-hour exam.
    • Score of 95 (equal to approximately 72% correct) to pass.

    Recertification occurs every five years. Recertification eligibility criteria include:

    • Hold a current CCCTM nursing certification
    • Hold an unencumbered and current license as a Registered Nurse (RN) in the United States or territories
    • Have accrued 1000 practice hours in care coordination and/or transition management setting in the last 5 years and
    • Have earned 90 contact hours in the last 5 years
    • $275 fee

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    Part Four What is the Career Outlook for an RN Case Manager?

    Currently, there is no exact career outlook data for case managers. According to the BLS, in 2018, there were 3,059,800 Registered Nurses in the United States. By 2028, there will be a need for additional 371,500 nurses, which is an expected growth of 12%. With the aging population, this number is expected to be even higher.

    Because RN Case Managers generally work with the older population with chronic health conditions, the need for this highly specialized field will continue to rise. Furthermore, there is an increasing need for nurses throughout the United States and this number will only continue to rise.

    Part Five What Do RN Case Managers Do?

    Case Managers are often the glue that holds a team of healthcare professionals together. They are involved in the coordination of care of an individual patient to identify resources and services best suited for the patient. 

    Case Managers will often have multiple patients they manage at any given time and will continue to follow those patients if they are re-admitted. Often, the patients that are frequently hospitalized or seen in an outpatient clinic will be flagged so the case manager is aware of their presence in the healthcare system.

    Case Managers generally work with patients that have chronic health conditions such as diabetes, heart disease, seizure disorders, and COPD. While it is possible for a Case Manager to work with any patient in the hospital, most of their caseload is patients that require additional monitoring and follow-up, as well as considered high risk.

    Case Managers more specifically perform the following duties:

    • Decrease hospitalizations for high-risk individuals
    • Identifying client needs, current services, and available resources, then connecting the client to services and resources to meet established goals
    • Screening clients and/or population for healthcare needs
    • Collaborate with other healthcare professionals
    • Assist transfer to facilities and other care environments
    • Oversee systems for identifying high-risk patients through EMR, referrals, registries from health insurance payers
    • Oversee the discharge process
    • Book their patients’ doctor appointments and follow up to make sure they keep them.
    • Serve as a resource for their patients, offering education and guidance to patients and their families as they navigate complex medical decisions.
    • Develop and manage the overall long-term health care plan for patients with chronic or serious conditions such as Alzheimer’s disease, diabetes, and heart disease.
    • Develop a tracking system for patient care coordination and care management across the continuum, including care transitions, Primary and Specialty Care.
    • Act as clinical liaison for Payer Based Care Management programs
    • Follow-up with patients within 24 hours on inpatient discharge and within 48 hours of ED visit notification
    • Monitor medication usage by a patient
    • Monitor and update treatment plans to reflect the patient’s current condition
    • Assist patients in navigating the health care system.
    • Coordinate Specialty care, follow-up on test results and other care coordination needs.
    • Promote self-management goals
    • Research the latest treatments and procedures in their chosen area of specialization
    • Partner with external case management programs to coordinate care
    • Educating the client/family/caregiver about the case management process and evaluating their understanding of the process
    • Developing a client-focused case management plan
    • Promote quality, cost-effective care, and patient outcomes

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    Part Six Where do Case Managers Work?

    Case Managers can work in a variety of settings. Most commonly they are found in the following areas:

    • Hospitals
    • Insurance Companies
    • Long-term care facilities
    • Medical supply companies
    • Hospice
    • Palliative care
    • Community health centers
    • Public health centers
    • Oncology outpatient centers
    • Outpatient clinics
    • Home healthcare companies
    • Government agencies

    Part Seven What are the Continuing Education Requirements for an RN Case Manager?

    RN Case Managers have the same continuing education requirements as other RNs. This will vary on a state by state basis. While there are no specific CEU requirements for a Case Manager, specific certifications require CEUs. If an advanced certification is held, individuals should refer to the accrediting organization’s website for specifics regarding the CEUs.

    Generally, in order for an individual to renew their RN license, they will need to fill out an application, complete a specific number of CEU hours, and pay a nominal fee. Each state has specific requirements and it is important to check with the board of nursing prior to applying for license renewal.

    A detailed look at Continuing Nurse Education hours can be found here.

    Part Eight Where Can I Learn More about RN Case Managers?

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