(Continuation of the chat Q & A with Dr. Catherine Garner, Dean of Health Sciences and Nursing, American Sentinel Univeristy.)

Kindred Health:  Hi, this is Wendy DeVreugd, Sr. Director of Case Management, joining from Kindred Healthcare West Region.

Dr. Garner:  Welcome, Wendy.  There is some interest in employment here today.  Why do you encourage the Master's Degree in Case Management?

Kindred Health:  I encourage professional growth because we need not only the advanced nursing skills, but also the management skills to work and grow with each other.

NT.com:  Does one need to get a BSN before going straight into the MSN program?

Dr. Garner:  In our RN to MSN, you take six bridge courses in the BSN and then go directly into the master's program, which is 12 courses.  You do not earn the BSN but if you know you want the MSN, this program is more cost effective.

NT.com:  What does the case management field entail?

Dr. Garner:  Case management uses everything we know and do as nurses.  You need to understand the pathophysiology, disease management, coordination of care among various providers, and patient and family education – and you are very independent!

The field of case management is also seeing a new emphasis on professionalism.  A study by the Commission for Case Manager Certification (CCMC) reports that more employers are requiring case managers to be certified, and more employers are offering additional compensation for certification.  Often, it’s expected that a newly hired nursing case manager will become certified within three years of starting the job.

In addition to being more visible within the organization, case managers are likely to become more accountable.  In order to really deliver, they must know their employer’s specific clinical and financial goals and plan strategically to help the organization reach those goals, whether it’s increasing preventive screenings like colonoscopies or bringing down rates of avoidable readmissions.  As they become the central coordinator of multiple activities, case managers will have to be ready to assume authority.

Settings can vary.  Case managers may work for an insurance company monitoring a case load of at-risk pregnant mothers, do phone calls, arrange home visits and home fetal monitoring, or encourage visits to the physician.

A case manager can work for a hospital in more of a discharge planning role or arrange physician follow-up visits, medical equipment, etc. 

In a rapidly shifting landscape, nurse case managers will need to keep up with new care models like ACO's and should even take a leadership role in their development.  In addition to clinical skills and case management concepts, they will have to be knowledgeable about reimbursement models like capitation and pay-for-performance, as well as other financial matters.


NT.com:  What is the starting pay for a new case manager?


Kindred Health:  Pay differs according to the geographic region and wage index.  San Francisco is at 168% of the national average, and the state of California is at about 112%. In California, where I am located, case managers start at about $75,000.


NT.com:  Is it true that these positions will not be hospital-based?


Dr. Garner:  With the new accountable care organizations, these positions are more likely to be in the community.  Also, insurance companies are increasingly hiring case managers to manage those with chronic conditions.


NT.com:  What impact will accountable care have on insurance companies, Medicare, and Medicaid?

Dr. Garner:  Accountable care centers around a "case rate" payment similar to DRG's, so the one payment must be spread among multiple providers.

NT.com member comments:  Does anyone know of any training or educational program to become a case manager?

Dr. Garner:  American Sentinel offers an online MSN Case Management Degree – 36 credits or 12 courses.

Also note that the range of case management means that those with acute care and critical care backgrounds are needed as well as perinatal and pediatrics.  Much of the case load will be geriatrics in the future, as we all age.

I encourage you to consult the Case Management Society of America at cmsa.org.  This organization has chapters in many cities across the US and offers a good way to connect on a local level and interact with those in the field.  Also go to CareerBuilders.com and search "Case Management Jobs" to see what skills employers are looking for in a case manager.

NT.com member comments:  I am in the DNP program at American Sentinel University.  I have been in several online programs and I have to tell you that I love it!  The program is very user-friendly for the working nurse.

Dr. Garner:  Thank you!  For those looking for a doctoral program, American Sentinel offers a Doctor of Nursing Practice in Executive Leadership, a two-year online degree open to nurses with a MSN or another master's degree.

NT.com:  Are there any grants available to help pay for education?

Dr. Garner:  We have federal financial aid.  Also look to employers who provide tuition reimbursement.  If you are already CMSA certified you are eligible for 9 credit hours towards your Master's in Case Management – leaving just nine classes to achieve your MSN at American Sentinel University. See americansentinel.edu for more details.

NT.com member comments:  Can nurses use job experience for course credit?

Dr. Garner:  Yes. We have a process where you submit work experience for credit.  Your advisor can walk you through this process.

NT.com:  Are all case managers also nurses?

Kindred Health:  Case managers can be many people – one with a bachelor's degree in a health-related field or licensed to do independent patient assessment (RN, social worker).NT.com:  So do you foresee the replacement of current social workers and case managers who are not nurses?

Dr. Garner:  Social workers will always have a place, but I think that the complexity of care with disease management is going to place nurses at the center of this movement.

NT.com:  How can we access your article on accountable care?

Dr. Garner:  If you go to americansentinel.edu, there is a white paper on our blog giving more details on Accountable Care Organizations.

Kindred Health:  I would also like to note that Kindred Health is supporting growth of new nurses in case management.  We offer internships at some sites and a mentoring program.

NT.com:  What about opportunities to work from home?

Dr. Garner:  Many disease management companies hire nurses to work from home, as do insurance companies.  Check out CareerBuilders.com.


Dr. Garner:  To summarize, if you have your associate's degree in nursing, congratulations!  But it is not enough anymore since you will continue competing for positions with nurses who have higher education credentials.  You will also be limited in the future if you aspire to management or specialty positions.  If you do not have your BSN, now is the time to start your journey.  American Sentinel is here to help.  In addition, if you aspire to case management, nursing education, infection prevention and control, leadership, and health informatics, you are going to need a master’s degree.  Let’s face it; if you want to work alongside physicians with years of graduate education and pharmacists with doctoral degrees, you need to have the educational credentials to present yourself as an equal on the team.


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