What does a nurse case manager do?
A nurse case manager's role focuses on providing advice and medication to patients in an outpatient clinic or hospital. Typically, their responsibilities revolve around conducting extensive assessments, discussing essential matters to patients and families, devising efficient health care plans, coordinating with health care experts to share patients' progress, determining the needed care, and performing follow-up services. There are also instances when a nurse case manager must adjust medication or treatment as needed, refer patients to programs that will support them on their financial and other needs, and implement policies and regulations.
Nurse case manager responsibilities
Here are examples of responsibilities from real nurse case manager resumes:
- Develop and manage plan of care for symptom management for patients/families in home, ALF, and SNF arena.
- Maintain communication with commercial insurance payers, manage Medicare and Medicaid sources and conduct daily clinical updates to insurance companies.
- Coordinate surgery schedules with doctor, hospital, medical equipment representative and patients.
- General assessment and care/case management of Medicare patients including wind care, diabetes, cardiac complications, respiratory treatments.
- Deliver independent private duty nursing to pediatric patients in need of holistic care, including oxygen-dependent, ventilator-dependent, tracheostomy patients.
- Interview and assess patients, documenting findings and input into EMR system.
- Streamline patient throughput by identifying the most appropriate level of care using InterQual standards.
- Insure stay reviews are performed on all in-house patients in order to maintain CMS compliance.
- Administer oxygen per tracheostomy as needed.
- Administer chemotherapeutic agents to adult oncology patients.
- Participate in IDT meetings to certify/re-certify patients for continue care.
- Handle all in-coming calls including taking information for emergency surgery.
- Monitor oncology patients while receiving chemotherapy, completing radiation therapy.
- Determine severity of illness and intensity of service using InterQual criteria.
- Work collaboratively with local diabetes team, health professionals and community agencies.
Nurse case manager skills and personality traits
We calculated that 25% of Nurse Case Managers are proficient in Care Management, Discharge Planning, and Patients. They’re also known for soft skills such as Compassion, Emotional stability, and Physical stamina.
We break down the percentage of Nurse Case Managers that have these skills listed on their resume here:
- Care Management, 25%
Conducted assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
- Discharge Planning, 17%
Coordinate matters involving Medicare reimbursement, oversee Quality Assurance and Utilization Review issues, and coordinate discharge planning.
- Patients, 11%
Assist patients with establishment of care with specialty providers ensuring all medical/clinical notes and approved referrals are provided to gaining specialist.
- Home Health, 8%
Performed utilization reviews by authorizing home health visits for members recently discharged from a facility.
- Rehabilitation, 3%
Coordinated rehabilitation care for cardiac populations after various cardiac procedures/hospitalization.
- Medical Care, 3%
Advocated for patients with respect to approval for coverage for necessary medical care and advised state care-providers regarding appropriate medical decisions.
Common skills that a nurse case manager uses to do their job include "care management," "discharge planning," and "patients." You can find details on the most important nurse case manager responsibilities below.
Compassion. One of the key soft skills for a nurse case manager to have is compassion. You can see how this relates to what nurse case managers do because "registered nurses should be caring and empathetic when working with patients." Additionally, a nurse case manager resume shows how nurse case managers use compassion: "assist with discharge planning, utilization review, prior authorization, communication with physician, team player, compassionate"
Emotional stability. Another soft skill that's essential for fulfilling nurse case manager duties is emotional stability. The role rewards competence in this skill because "registered nurses need emotional resilience and the ability to cope with human suffering, emergencies, and other stressors." According to a nurse case manager resume, here's how nurse case managers can utilize emotional stability in their job responsibilities: "collaborate with interdisciplinary medical team to provide complex patient care and emotional support to patients and their families. "
Physical stamina. nurse case managers are also known for physical stamina, which are critical to their duties. You can see how this skill relates to nurse case manager responsibilities, because "nurses should be comfortable performing physical tasks, such as lifting patients." A nurse case manager resume example shows how physical stamina is used in the workplace: "home visits to new mothers, performing physical exams for mother and baby, providing health education and teaching parenting skills. "
Organizational skills. nurse case manager responsibilities often require "organizational skills." The duties that rely on this skill are shown by the fact that "nurses often work with multiple patients who have a variety of health needs." This resume example shows what nurse case managers do with organizational skills on a typical day: "documented clinical appropriateness of home health services per organizational policies and procedures, third party and medicare guidelines. "
Detail oriented. Another crucial skill for a nurse case manager to carry out their responsibilities is "detail oriented." A big part of what nurse case managers relies on this skill, since "registered nurses must be precise because they must ensure that patients get the correct treatments and medicines at the right time." How this skill relates to nurse case manager duties can be seen in an example from a nurse case manager resume snippet: "detail oriented with the reviewing files and surgeries for medical necessity and appropriateness based on diagnosis and causality. "
Communication skills. Lastly, "communication skills" is an important element of what a nurse case manager does. Nurse case manager responsibilities require this skill because "registered nurses must be able to communicate effectively with patients in order to understand their concerns and evaluate their health conditions." This resume example highlights how nurse case manager duties rely on this skill: "provide health education to patients regarding medication effects, surgical procedures, acute care discharge instructions, and therapeutic communication. "
The three companies that hire the most nurse case managers are:
- Alaris Health48 nurse case managers jobs
- Elevance Health
33 nurse case managers jobs
- REV Holdings LLC19 nurse case managers jobs
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Compare different nurse case managers
Nurse case manager vs. Utilization review nurse
The primary role of an Utilization Review Nurse is to analyze the condition of each patient carefully and decide if the patient still needs to stay in the hospital or be sent home. They deal with patients' relatives, doctors, and people from insurance companies.
These skill sets are where the common ground ends though. The responsibilities of a nurse case manager are more likely to require skills like "care management," "diabetes," "icu," and "excellent organizational." On the other hand, a job as a utilization review nurse requires skills like "acute care," "outpatient services," "clinical knowledge," and "appeals." As you can see, what employees do in each career varies considerably.
Utilization review nurses tend to make the most money working in the health care industry, where they earn an average salary of $67,742. In contrast, nurse case managers make the biggest average salary, $75,843, in the government industry.The education levels that utilization review nurses earn slightly differ from nurse case managers. In particular, utilization review nurses are 0.2% less likely to graduate with a Master's Degree than a nurse case manager. Additionally, they're 0.2% less likely to earn a Doctoral Degree.Nurse case manager vs. Hospice registered nurse
A hospice registered nurse is primarily responsible for assisting and taking care of patients admitted to hospice facilities. Their responsibilities revolve around devising specific care plans for every patient in coordination with physicians and other health care workers, administering necessary medication, helping patients cope with the symptoms of their ailments, and maintaining accurate records. Moreover, it is vital to visit patients regularly to assess their conditions, notifying doctors should there be any urgent updates. Furthermore, it is essential to build positive relationships with patients, supporting and making them feel comfortable at all times.
In addition to the difference in salary, there are some other key differences worth noting. For example, nurse case manager responsibilities are more likely to require skills like "care management," "medical care," "diabetes," and "icu." Meanwhile, a hospice registered nurse has duties that require skills in areas such as "hospice rn," "hospice services," "compassionate care," and "compassion." These differences highlight just how different the day-to-day in each role looks.
Hospice registered nurses earn a higher average salary than nurse case managers. But hospice registered nurses earn the highest pay in the health care industry, with an average salary of $65,811. Additionally, nurse case managers earn the highest salaries in the government with average pay of $75,843 annually.In general, hospice registered nurses achieve similar levels of education than nurse case managers. They're 2.3% less likely to obtain a Master's Degree while being 0.2% less likely to earn a Doctoral Degree.What technology do you think will become more important and prevalent for nurse case managers in the next 3-5 years?
Kathrine Skurski
Nursing instructor, Morton College
Additionally, handheld and Bluetooth-enabled devices will become more prevalent in the next few years. Many nurses already carry a phone in their pocket to answer call-lights or page a provider. However, the newest phones or devices will now record and upload assessments or diagnostic tests into the medical record. This generates efficiency in inpatient care. Bluetooth-enabled EKG machines and stethoscopes are becoming commonplace devices in many medical offices. It is only a matter of time before larger organizations purchase these technologies for bedside care.
Nurse case manager vs. Senior registered nurse
A senior registered nurse is a superior healthcare professional who provides high-quality palliative care to patients and their families. Senior registered nurses are required to liaise between patients and other healthcare professionals, such as physicians, occupational therapists, and physiotherapists. They lead a team of registered nurses and care assistants to ensure that they follow the hospital's best practice care standards. Senior registered nurses also administer and order medicines as required by patients and the hospital's policies and procedures.
There are many key differences between these two careers, including some of the skills required to perform responsibilities within each role. For example, a nurse case manager is likely to be skilled in "care management," "diabetes," "social work," and "excellent interpersonal," while a typical senior registered nurse is skilled in "acute care," "bls," "triage," and "appeals."
Senior registered nurses make a very good living in the health care industry with an average annual salary of $85,104. On the other hand, nurse case managers are paid the highest salary in the government industry, with average annual pay of $75,843.Most senior registered nurses achieve a similar degree level compared to nurse case managers. For example, they're 1.7% less likely to graduate with a Master's Degree, and 0.0% less likely to earn a Doctoral Degree.Nurse case manager vs. Triage register nurse
A triage register nurse works at a hospital's emergency room where they are in charge of providing immediate care and assistance to patients who are usually in life-threatening conditions. Part of their job is to assess the patients' needs and symptoms, regularly check on the patients who are in the waiting areas, assist patients towards corresponding facilities, and sort priority groups according to guidelines. There are also instances when a triage nurse must initiate urgent treatment or receive calls, maintaining an active communication line with fellow nurses and staff for an efficient workflow.
Even though a few skill sets overlap between nurse case managers and triage register nurses, there are some differences that are important to note. For one, a nurse case manager might have more use for skills like "care management," "discharge planning," "rehabilitation," and "diabetes." Meanwhile, some responsibilities of triage register nurses require skills like "triage rn," "telephone triage," "test results," and "acls. "
The health care industry tends to pay the highest salaries for triage register nurses, with average annual pay of $69,032. Comparatively, the highest nurse case manager annual salary comes from the government industry.triage register nurses reach similar levels of education compared to nurse case managers, in general. The difference is that they're 1.4% more likely to earn a Master's Degree, and 0.4% less likely to graduate with a Doctoral Degree.Types of nurse case manager
Updated January 8, 2025
