How Can I Become a Medical Case Manager?

Research what it takes to become a medical case manager. Learn about job duties, education requirements, training, licensure and salary to find out if this is the career for you. Schools offering Health Care Administration degrees can also be found in these popular choices.

What Is a Medical Case Manager?

A medical case manager helps coordinate a patient's treatment and health care experience. The two primary pathways to this career are by becoming either a registered nurse (RN) or a social worker with an emphasis on the medical field. Upon achieving a position as a medical case manager, these professionals facilitate interactions between doctors, medical staff members, patients and insurance companies. In this way, they manage both the treatment-related and financial aspects of the patient's case. In addition, they may compile data from multiple patients' cases and conduct analyses that can be used to improve services and outcomes in the future.

The following table gives general information about these career options.

Registered Nurse (RN) Case Manager Healthcare Social Worker
Degree Required Associate's degree; bachelor's preferred Bachelor's degree; master's preferred
Education Field of Study Nursing Social work
Training Required Dedicated nursing program Two years of clinical practice
Licensure Nursing license required Clinical license required
Average Salary (2015) $71,000 (for registered nurses)* $54,020 (for healthcare social workers)*

Source: *The U.S. Bureau of Labor Statistics

What Does a Medical Case Manager Do?

As a medical case manager, you would oversee the total health care experience of patients. The elements of a case include diagnosis, assessment, insurance management, treatment analysis and outcome evaluation. You would collaborate with doctors, nurses, patients and caregivers to coordinate the plan of care during a hospital stay. You also might provide psychological and practical support for patients dealing with chronic or acute illnesses as well as terminal diseases.

The case management process includes helping a patient prepare to return home after an extended hospital stay, course of treatment or disability. You also might arrange for home meal delivery and at-home care, transportation for follow-up appointments and long-term care solutions. Additionally, you would maintain knowledge of human services agencies and other organizations that could provide assistance to patients.

How Can I Enter this Profession?

There are two primary pathways to becoming a medical case manager: registered nurse (RN) or social worker. As an RN, you would need to have an associate or bachelor's degree in nursing and to be licensed by the state where you work. You might find that most medical case manager positions require a bachelor's degree, and some employers prefer or require a master's degree.

As a social worker, you would be required to hold a bachelor's degree; however, social workers in the medical field often need a master's degree. Social workers can become licensed after two years of clinical practice.

Where Might I Find Employment?

As a medical case manager, you might find employment in a hospital or nursing care facility or with a managed care organization or insurance company. As a social worker who is also a case manager, you might find employment with a family service organization or government human services agency as well.

Can I Earn Professional Recognition?

There are several voluntary certification options available, depending on your place of employment and level of education. For example, you can obtain the Accredited Case Manager designation through the American Case Management Association. This certification is designed for social workers and registered nurses employed at hospitals. The Certified Case Manager designation from the Commission for Case Manager Certification is available to RNs with an associate degree or higher level of education. A licensed RN or someone with a bachelor's degree may become a Certified Disability Management Specialist.

What Salary Can I Expect?

In 2015, the Bureau of Labor Statistics (BLS) reported that all registered nurses, including those performing case management, could expect a mean annual salary of $71,000. Job growth is on the rise at 16% from 2014 to 2024, significantly higher than the national average, due to the growing emphasis on preventative and treatment healthcare. The BLS also reported that in 2015, healthcare social workers earned a national average of $54,020.

What Are Some Related Alternative Careers?

Instead of becoming a medical case manager, you could seek a higher-level position in health services management. For instance, you could become a nursing home administrator, where you would be responsible for overseeing all operations within a long-term care facility, including staff scheduling, budget allocations and facility maintenance. For this, you usually need at least a bachelor's degree. Another option is a job as a health information manager, where you would be responsible for organizing and securing patient records in databases. The minimum educational requirement is a bachelor's degree, but it is important to have expertise in both healthcare and information technology.

To continue researching, browse degree options below for course curriculum, prerequisites and financial aid information. Or, learn more about the subject by reading the related articles below:

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