How to Become a Nurse Case Manager

Nurse case managers fulfill an important role in healthcare delivery. When patients have serious injuries or complex illnesses, navigating the many aspects of their healthcare can feel overwhelming. Nurse case managers help coordinate patients’ care, ensuring that they have the services and resources to support the best outcomes.

The following guide includes details about becoming a nurse case manager, including the required education, experience, and skills. We also cover what you might expect in this important role.

Nurse case managers coordinate care for geriatric patients and those recovering from a serious injury or navigating complex or chronic conditions. They may work in a hospital, long-term care facility, hospice, or for an insurance company. Regardless of where they work, nurse case managers are committed to ensuring patients get necessary and comprehensive care.

Case managers collaborate with other healthcare providers and payers to develop care plans for patients that offer the best results and value. This includes advocating for the patient, providing education, coordinating and monitoring the implementation of the plan, and communicating with all stakeholders.

For example, hospital case managers may help a patient access financial resources for care or develop a discharge plan and ensure the patient has access to follow-up care.

Nurse case managers are experienced, licensed RNs. While it’s possible to qualify for an RN license with an associate’s degree, many employers prefer to hire nurses with at least a bachelor’s degree. However, once licensed, RNs can work under more experienced case managers, gaining the experience necessary to apply for board certification.

Because nurse case managers need a valid RN license, they also need a nursing degree. Although a two-year ADN degree is the shortest pathway to licensure, many employers require or prefer nurse case managers with four-year BSN degrees.

An ADN degree offers a faster path for someone who wishes to become a nurse and begin working in the field within two years. However, while the degree does meet the minimum eligibility for the NCLEX-RN and state licensure, some employers may prefer or require a bachelor’s degree for entry-level nurse case manager positions.

A four-year BSN degree prepares nurses for the NCLEX-RN and state licensure. This credential may be required or preferred by some nursing employers. A BSN also positions nurses to pursue advanced degrees and higher-level practice, along with greater earning potential. BSN programs include upper-level coursework to improve critical thinking and patient care skills.

Nurse case managers must hold a valid RN license. State nursing boards determine the criteria to issue and renew RN licenses, so requirements to maintain license vary by state. Thirty-nine states require continuing education to renew a nursing license, and every state is different. Some states require specific courses, while others determine the number of hours based on experience. Visit AAACEUS for a list of state-specific requirements.

Although there is no legal requirement for a nurse case manager to be board certified, some employers may prefer or require the certification. Nurse case managers can earn the Case Management Nurse – Board Certified (CMGT-BC™) credential after two years of nursing experience and 2,000 hours of case management experience. The certification indicates that a nurse case manager has demonstrated competency in nursing and case management.

Nurse case managers can work in a variety of settings, including healthcare facilities and insurance companies. Case managers often begin their careers as bedside nurses and transition into roles that require more case management tasks. In many cases, nursing knowledge and experience can qualify you for entry-level case management positions that provide the experience necessary for certification.

Those working in clinical care settings like hospitals or nursing homes are closely involved in family education and support, discharge planning, and connecting patients with resources. Case managers working for insurance companies or other payers are likely to focus on developing care plans and coordinating care for complex cases.

According to Payscale, the average salary for a nurse case manager is $75,300. Although the Bureau of Labor Statistics does not list occupational information for nurse case managers specifically, they project that demand for medical and health managers will increase by 32% between 2020 and 2030. This is mainly attributed to an aging population increasing the demand for cost-effective healthcare.

Nurse case managers must have a nursing degree, which requires at least two to four years of education. Certification requires at least two years of nursing experience, plus 2,000 hours of work experience as a case manager.

It is possible to become a nurse case manager with a two-year ADN degree and a nursing license. Most employers require case managers to have experience in nursing to take on entry-level roles, but the minimum years of experience varies. Look for positions that include case management responsibilities to gain experience.

Nurse case managers focus on patient outcomes, developing cost-effective care plans in collaboration with clinical and nonclinical care providers. This might include discussing treatment options with providers and educating families, coordinating support from social workers and counselors, and following up to ensure that care plans are followed.

A nurse care manager, in contrast, focuses entirely on the clinical aspects of care, coordinating different providers to ensure the best and most cost-effective outcomes for all patients.

Nurse case managers need to be organized and detail-oriented with excellent communication and collaboration skills. Case managers manage different perspectives and priorities with compassion and diplomacy, focusing on providing value and keeping costs in check.

Page last reviewed May 18, 2022