Tight economy swells demand for case management certification

Do you know which credential is right for you?

The field of case management has yielded a variety of credentialing opportunities that provide a daunting landscape for case managers seeking certification. Several industry veterans say the increasingly competitive job market makes those decisions more important then ever.

According to Lori Heiser, LSW, CMC, case manager at St. Joseph’s Hospital and Health Center in Dickinson, ND, the question of which certification carries the most benefit has been relevant for some time. But she says there is no clear evidence to answer that question.

There are myriad certifications, and some are more credible then others depending on how they are developed and maintained, says Janet Maronde, RN, executive director of the Healthcare Quality Certification Board (HQCB) in San Gabriel, CA, which administers the Certified Professional in Healthcare Quality (CPHQ) credential.

It is difficult to stay abreast of the core body of knowledge of all the various programs, she adds. "I am in the business, and I would not even profess to be familiar with all of the certifications that are out there," Maronde says.

"Case management is still being pioneered, and it is difficult to say that what works for one facility will work for another," Heiser points out. The options are so numerous that even determining what criteria to look for in assessing different credentialing agencies is a difficult task, she says.

According to Susan Gilpin, chief executive officer of the Commission for Case Manager Certification (CCMC) in Rolling Meadows, IL, which has certified more than 22,000 case managers, CCMC is seeking to remedy that concern.

Hospital case managers typically are concerned about the eligibility criteria, and some of those issues currently are under review by the CCMC, Gilpin says. The primary issue has been an eligibility requirement, which states that case managers should provide services "across the continuum of care in multiple environments," she says.

"The debate has been whether . . . the services hospital case managers provide extend across the continuum of care and outside the walls of the hospital," Gilpin explains. "That has probably been the biggest stumbling block for hospital case managers as the commission has worked to interpret and apply the eligibility criteria to this practice setting."

Specifically, Gilpin reports that the CCMC has established the Certification Eligibility Review Task Force to assess the interpretation and application of the definition of "the continuum of care" through research that includes a survey of practitioners. The eligibility criteria may not be changed, but how those criteria are applied possibly could be changed, she adds.

"We want to make sure that the case management credential reflects the field," asserts CCMC chair Patricia McCollom, MS, RN, CRRN, CDMS, CCM, CLCP, who points to a demonstrated growth in the number of case managers, especially hospital case managers.

When the CCM credential was initiated, the largest number of applicants came from the insurance industry and independent case management companies, she notes. "At this point, the largest number of applicants are from hospitals."

As the field has evolved, concerns have surfaced among hospital-based case managers regarding the relationship between their work responsibilities and the eligibility criteria for the CCM credential, she says.

In addition to evaluating the field as it exists, the task force is conducting a research project that will review the job descriptions from all applicants, McCollom says. "We are going to take a large number of the job descriptions and review those for consistency with what the research says. That may make a difference in how those criteria are applied."

Maronde says she fields numerous phone calls from potential applicants asking if a certain certification will guarantee them a job. "It won’t, unless you are interviewing with an employer that requires it." According to her organization’s latest survey, only 5% of employers require certification, while 70% prefer it.

That may be changing, however. While the process itself is voluntary, more organizations soon may require it, says Catherine Mullahy, RN, CRRN, CCM, national president of the Case Management Society of America (CMSA) based in Little Rock, AR. She emphasizes that CMSA, a national organization representing case management professionals from many disciplines and practice settings, does not administer or endorse any particular certification or credential. "We do, however, certainly support certification and encourage our members to pursue the one that best fulfills their professional needs," she says.

With so many certifications to choose from, Mullahy says, case managers need to educate themselves about the various ones available in order to make the best decision for their current and future career goals. "Our web site, www.cmsa.org, has general information on the various certifications."

Shannon Carter, executive director of Certification Boards, Perioperative Nursing in Denver, says her organization is in the process of conducting research into the value of its certification programs. "We are surveying certified nurses, noncertified nurses, and people who hire certified nurses to find out the value to them of that credential."

In addition to personal motives, pay differentials are becoming more evident between certified and noncertified nurses, Carter says. Her organization has certified 30,000 perioperative nurses, a small minority of whom are case managers.

Gilpin contends that the recent slowdown in the economy means that many case managers may not have the luxury of remaining in their current position.

In that instance, case managers may want to select a credential that is both nationally recognized and broad enough in scope to offer the most flexibility rather than a narrowly focused specialty or discipline-specific credential. "A specialty or a discipline-specific credential may limit a case manager’s job opportunities to specific practice settings, whereas a credential such as the CCM tells an employer that the case manager has the skills and experience necessary to be an effective case manager in any practice setting," she says.

The current nursing shortage also is likely to have an impact, McCollom says.

"Simply put, case management is an advance practice, and if there are not people entering nursing, there won’t be people in it long enough to assume that role," adds Gilpin.

Carter says that the managers she interacts with most indicate that if they had a choice between a certified nurse and a noncertified nurse, all other things being equal, they would prefer certification.

One question a case manager should ask is what the facility might require. But an even more important question is what are individual case managers seeking in terms of their future career goals? Maronde says. "We advise people to look at the content of the various programs and think about their career goals."

Maureen McKenna, RN, LSW, director of care management at Lifespan/Physicians PSO in Providence, RI, says the Credentialing Advisory Board for the Certification of Case Management Administrators recently initiated two new certification programs specializing in social work. Those exams are designed to gauge how current administrators are in health care trends and case management, she says. They also assess how well case managers interpret data and use the data to demonstrate the impact of their programs.

According to Maronde, if case managers want to practice "hands-on" case management that focuses on patient care, there are several certifications that fall in that area. On the other hand, she says, the CPHQ credential is a "renaissance credential" that covers a variety of related fields. "We advise that if you want to go into a more administrative role, this is the credential to seek."

Candidates seeking this certification typically go beyond patient-focused case management. "They may have case management as part of their responsibilities, but they probably are also doing quality and perhaps infection control and risk management," she says. "All of that content is on our exam, whereas some of the others are more focused."

Another consideration for case managers is whether to pursue an accredited program or a nonaccredited program, Maronde says. Some programs such as HQCB enjoy the National Commission for Certified Agencies accreditation. However, most do not.

Yet another question that arises is which combination of certifications to secure. According to Maronde, many case managers have both the CCM and CPHQ certification, while many others combine the CPHQ and the risk management credential. "Many of our case managers are also infection control practitioners. We have a lot of dual-credentialed people in our group."

The equation also varies according to geographic region. "If you are on either coast, you are much more likely to need a credential then if you are in the midsection of the country," contends Maronde. To date, there are not many state requirements regarding case manager certification. Florida currently requires risk managers to have risk manager certification. However, that requirement falls more in the category of certificate then certification, she says. Candidates simply take a course that runs 120 hours and take a test, she explains.

As states become more involved with case management, however, some may require staff to be certified in order to contract with an agency for case management services, Mullahy says.

"It gets very confusing for everybody," Maronde says. And it is likely to get even more complicated, she predicts.