Executive Summary

The case/care management career path is wide open, experts say. Career growth can be in a variety of settings and organizations, depending on the individual case manager’s interests and talent.

• A nursing foundation remains important.

• Case managers also should seek certification and keep up with education and training.

• Population health and patient navigator roles are becoming increasingly important for CMs.

 

Case and care managers in today’s healthcare arena can create a career path that will take them to any care setting, case management experts say.

“I think they have a huge opportunity,” says Peggy Crabtree, RN, MBA, vice president of The Camden Group, a healthcare management and consulting firm in Los Angeles.

Case managers (CMs) can go into various settings using their acquired skills, and be very successful, she adds. “This is probably one of the areas where they have the greatest opportunity for growth,” she says.

Case management requires unique skills that help patients transition and move across the continuum of care, she notes.

“Case managers have the ability to touch every aspect across that continuum,” Crabtree adds.

However, case and care managers face the primary challenge of lacking a clear and simple career path, says Bridget Gulotta, RN, MSN, MBA, senior consultant for The Camden Group in Chicago.

Career growth can take them to different settings and organizations where the roles and responsibilities are often very different, Gulotta explains.

“Some use case managers with a more utilization management [UM] focus, while others need discharge planners or a combination of both,” she says.

Unlike many other careers, there’s not a simple definition for a career trajectory, and CMs might make their upward or lateral moves based on their organization’s leadership.

“Without having those defining career paths or having a culture that promotes career development, it’s difficult for care managers to get the experience and full breadth of development they could and should,” Gulotta says.

With new healthcare payment models such as bundled payment, care management is less acute-care focused than previously, Crabtree notes.

“Traditional case management has been inpatient-centric,” she says. “So the skillset is being able to work in multidisciplinary teams and to have good communication skills.”

Traditional CMs also needed to work with physicians, hospitalists, and others in healthcare. While these skills still are important, there are many more that CMs need to have for thriving careers. Crabtree and Gulotta suggest the following strategies and directions for creating a case management career pathway:

Training from the ground up: Nursing education and experience remain among the most important foundations for case management careers, Gulotta notes.

“For ex-nurses there are many paths you can take,” she says. “Care management, especially now as this role is evolving and growing in so many different areas, is one path.”

Nurses and nurse practitioners also can easily transition into patient navigator roles, Crabtree says.

“Nurse navigators assist with transitions,” she adds. “Health plans have made important changes where we’re seeing a more proactive approach, so we can avoid readmissions or additional complications.”

Nurses also have the background training necessary for becoming case managers who specialize in a particular disease area, such as diabetes or congestive heart failure, Gulotta says.

“I was an emergency department nurse and hepatology clinical coordinator,” she explains. “While this wasn’t technically a case manager position, it was a clinical position to help hepatology patients coordinate care outside the hospital, whether through patient education or hepatitis C treatment or referrals to one of our hepatology surgeons.”

The clinical experience is essential for CMs who want to run a program for a particular disease, Crabtree says.

“If I was looking for someone to run a diabetes program, I would look for someone with that clinical expertise,” she adds.

Certification and education: When seeking new jobs and career opportunities, CMs should show that they have had some progression and growth in their career, Crabtree suggests.

“I would look at their skills in terms of additional education, and I’d like to see that they participated in different activities — to see that they go outside their comfort zone,” she adds.

The importance of CM education has increased, although it’s still left up to individual CMs, Gulotta says.

“A lot of programs offered online focus specifically on care management as a full curriculum where you receive a certificate in care management,” she explains. “This education gives you a broad perspective of what care management looks like.”

Healthcare organizations, associations such as the Case Management Society of America (CMSA), healthcare consultants, publishers (including Case Management Advisor), and others offer conferences, educational webinars, continuing education resources, and Web-based learning platforms, Gulotta notes.

Case managers can easily find educational resources for any type of learning they might desire, she adds.

Also, they should consider seeking certification, Gulotta says.

Professional certification is a valuable career-building tool, although — like CM education — there are fees, she adds.

“Certification groups provide care managers with a great deal of information about the future of care management, and they’re a good vehicle to keeping yourself abreast of changes in the field,” Gulotta adds.

“Another thing that’s very helpful as we continue to move into this value-based environment and away from the volume-based environment is the lunchtime webinar,” she says. “There are so many organizations that do webinars at lunchtime, and I think that’s a great way to see what’s going on.”

Plus, many of these have no cost and are held during lunch, giving CMs a break from the daily work schedule.

Population health: While the basic skills CMs need are the same across jobs and work settings, population health is an area that might suit one person more than another.

“One characteristic in population health is they may have a particular clinical area they have a passion for, like diabetes or congestive heart failure or orthopedics or total joint,” Crabtree says.

In population health, the model that is becoming more prevalent under the Affordable Care Act, the responsibilities of practitioners delivering care and supporting care is shifting, Gulotta says.

“Disease management and co-management of multiple conditions are very important,” she adds.

From a case management perspective, co-management of multiple conditions is a pivotal role under the population health model.

“In a hospital setting, the case manager probably doesn’t have a big opportunity to educate a patient or help an individual connect all the dots,” Gulotta explains.

In the traditional model, CMs help patients during the hospital discharge, and they might assist with follow-up appointments, but the new paradigm is multifactorial, Gulotta says.

“You’re looking at taking a proactive, preventive approach to caring for these patients, whether it’s keeping them well or helping individuals manage their chronic conditions,” she says. “These include management of personal health behavior if they smoke or helping them cease their tobacco use or providing fitness programs that help them lose weight or dietary programs to help them eat better.”

In the traditional system, healthcare providers told patients what they needed to do to improve their health, and a patient might or might not follow that advice, Gulotta notes.

“Now, case managers are asking patients to be active participants in their health,” she adds.

Population health — as a career pathway — will continue to grow and offer opportunities to case managers, Crabtree and Gulotta say.

Patient navigator: This role is another major career pathway for case managers and, like population health, it’s an area that is becoming increasingly important under the evolving healthcare structure.

“Population health navigators are those case managers who are working in an accountable care organization [ACO] or patient-centered medical home, and they’re helping guide clinical care for patients,” Gulotta says. “Ideally, as we change this paradigm, that care manager should be the first point of contact for a patient and the care manager should be the common thread for weaving the patient through ambulatory care setting, the hospital, and back out.”

Patient navigators are part of the service line structure, Crabtree says.

“For example, when we built a women’s imaging breast cancer center, there was a nurse practitioner who worked as a navigator with patients, helping them maneuver the system and working with insurance plans to get services covered,” she says.

Patient navigation is very successful in oncology where patients’ health needs are complex, she adds.

Oncology patients often find it confusing to manage doctors’ appointments and follow medical instructions when one physician says one thing and another says something else, Crabtree explains.

Patient navigators help them coordinate messages from various specialists and assist with communication, which is critical, she says.

“Case managers have the ability to look at things from the patient’s viewpoint and anticipate their barriers,” Crabtree says. “They have the ability to be great problem-solvers and can handle complex issues and facilitate a team.”

Leadership potential: CMs with the ability to manage complex issues and populations also have the potential to move into leadership roles, Crabtree says.

“I think recruiting for a strong leader in a case management or care management role is very, very tough,” she says. “The clients we work with often struggle finding someone with the right skillset to do that role.”

So CMs with leadership potential should consider this for a career path, she adds.