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Nurse Case Managers: Putting a Friendly Face on an Unfriendly Business

Health plan providers are typically viewed by subscribers as large, impersonal conglomerates. Nurse case managers are changing that perspective, one patient at time.

Major health-plan providers employ thousands of nurses as nurse case managers. Although these nurses don’t deliver life-saving meds or monitor vitals , their jobs are just as critical to patients’ health as their counterparts’ jobs in clinical settings.

Nurse case managers employed by health plan providers help chronically ill patients better manage their long-term care. They build one-on-one relationships with the patients, providing support, education, and often, reminding them of regular appointments, screenings, and treatments. And they do it all via telephone.

“If you go to these nurses’ offices, they usually have their headphones on,” says Nancy Valentine, RN, vice president and national nursing executive of medical policy and health strategy at Cigna. “There are pictures of their children or their dog on their desk. Then, hanging all around their cubicles, are letters and pictures the patients have sent to them. It is quite remarkable; the informal relationship-building is very powerful on the phone.”

A lot of patients have a tough time dealing with their illnesses, says Valentine, especially chronic diseases like asthma or diabetes. That’s why health-plan providers have developed disease-management programs, which employ nurse case managers to help improve patients’ quality of life — and ultimately, save the managed-care organization the long-term costs of treating complications that arise when patients don’t care for themselves properly.

Most plans offer disease-management programs that focus on costly chronic illnesses, such as diabetes or asthma. In addition, some healthcare plans offer shorter-term management programs, such as prenatal care that is designed to help pregnant moms take the appropriate precautions to prevent pre-term deliveries.

Generally, nurse case managers work in one of the specialty areas in which they have previous experience. Case management is becoming increasingly customized and sophisticated, says Valentine, “so we try to match nurses with certain backgrounds with the appropriate disease management program.” Cigna also cross-trains case managers to have working knowledge of other disease areas, since about 25 percent of patients suffer from multiple illnesses and take part in more than one disease-management program.

What do health plan providers look for when hiring nurse case managers? Valentine notes there isn’t a “one-size-fits-all” aspect to hiring, but they do look for “baccalaureate-prepared people. It’s also important that [nurses] understand how the continuum of care flows for the care of a client.”

Brad Holliday, vice president of human resources for AdvancePCS, says it’s also helpful for nurses to have managed-care experience. Although that’s not a requirement, it’s a highly desired part of the job description at his company, which provides outsourced disease-management programs for large plans like Tufts Health Plan.

Nurses with exceptional communication skills, especially listening, make the best case managers, adds Nancy Harrison, RN, director of care management for Cigna’s Well Aware disease-management program.

“Nurses are trained to respond to cues they hear from people. This job requires more of an ability to listen for verbal cues than the visual cues nurses observe in a clinical setting,” she says. “Nurse case managers’ jobs include listening, understanding perceived barriers, and coaching patients.”

It’s this opportunity to communicate one-on-one and build long-term relationships that draws many nurses to case management. Holliday says many nurses also indicate they moved into case management because they wanted the chance to be more proactive in their approach to care than they could be in a clinical setting.

Positions for case managers are relatively easy to find, due to the current nursing shortage. Although the managed-care industry isn’t as short-staffed as many clinical facilities, Holliday says he almost always has one or two positions open.

Part of the attraction to the field also may be the steady hours and the pay rate. Nurse case managers can make yearly salaries between mid-$40,000s to around $100,000, depending on the location of the position, their experience, and the level at which they are hired.