Case managers are responsible for helping their patients understand their health status and coordinating long-term care. According to The Journal of Nursing Scholarship, more than 93 percent of the case-management workforce is made up of registered nurses. We recently spoke with Mary McLaughlin Davis, DNP, ACNS-BC, NEA-BC, CCM, president of The Case Management Society of America (CMSA) to learn more about the critical role that case management nurses play in patients’ lives.
Nursing Notes (NN): Can you share a little bit about your nursing career trajectory?
Mary: The decision to become a nurse is one of the best I have made in my life. I worked as a psychiatric nurse, a pediatric nurse, a public health nurse, and in a medical ambulatory care clinic, before I joined an acute physical rehabilitation hospital. This is where I first learned about case management. A case manager from an insurance company contacted our admissions office to learn about an injured worker, who was one of our patients. At the time, it was unheard of to discuss a patient with an insurance company, but over time it became an acceptable practice and we learned how much the case manager could do for the patient.
I later became the director of case management for another acute rehabilitation hospital and my case management education accelerated. I became a certified case manager, completed a master’s degree in nursing, was certified as a clinical nurse specialist and an advanced practice nurse, and later earned a doctorate degree in nursing. Currently, I am a senior director for care management for three Cleveland Clinic Hospitals and serve as the national president of the CMSA.
NN: What kind of work does a case manager do?
Mary: Although it is not exclusively a nursing role, most case managers are nurses. Case managers help patients understand their diagnosis, options for treatment, and the complex healthcare system. Case managers work in settings across the continuum of care. A case manager may work for a large or small health insurance provider, in workers' compensation insurance with a selected population of patients, or in acute care hospitals, providing support and guidance to patients in the care coordination process. They may work with patients who are designated as high risk, or patients with chronic diseases, such as heart failure or Chronic Obstructive Pulmonary Disease (COPD).
NN: Why is the case manager a critical role in patient care?
Mary: Today more than ever, with the change from a fee-for-service to a value-based medical model, and the shift to population health – an approach that aims to improve the health of an entire population – case managers can be the key to success. The unique services a case manager provides are essential to helping patients manage their own health.
NN: How do you see the field of case management changing over the next 10 years as medical technology continues to advance?
Mary: Population health models will create extended teams of case managers and non-licensed case manager extenders who will manage large groups of patients. A case manager may be responsible for overseeing patients in different states with his or her team of experts. Telehealth will also play a role in this change, as it will allow the case manager to care for many more patients.
NN: Can you tell us about CMSA?
Mary: CMSA is the leading membership association providing professional collaboration across the healthcare continuum. The organization aims to advocate for patients’ wellbeing and improved health outcomes by fostering case management growth and development, impacting healthcare policy, and providing evidence-based tools and resources.
NN: What advice would you give to a nursing student who is interesting in becoming a case manager?
Mary: I would tell any nursing student seeking to specialize in a particular field to spend at least one year in medical-surgical nursing. It is challenging work, but it is satisfying and rewarding. In my opinion, medical-surgical nursing is the foundation for nursing practice. Additional fields in nursing that will provide good preparation for case management are home care, hospice, public health, acute rehabilitation nursing, and emergency department nursing.
NN: Is there anything else you would like to add?
Mary: Case management is a challenging and rewarding field. The nurse case manager has to think outside of the box and explore every possible method to help his or her patients.