Masters in Nursing Case Management
This degree provides training for an essential role in the healthcare systems environment: management of individual patient records and treatment protocols with regard to providers and third party payors, and advocacy on the part of the patient. Case management has become a mandatory function within most medical organizations, including individual medical practices, hospitals, treatment centers, insurance companies, and of course the major government organizations such as Medicare and the Medicaid state plans. A Masters in Nursing Case Management degree may launch a career that begins as a desk job, but it can mature into an important managerial role in guaranteeing quality healthcare for patients.
For most case management nurses the focus is on clinical management and evaluation rather than the insurance side of the industry. For those treatment modalities that require preapproval generally an office staffer will contact the insurer for clearance. In some cases however the medical expertise that is required in order to obtain clearance requires training at the MSN level; some insurers want to hear from an advanced practice nurse or a MD before signing off on an expensive procedure. So that can be one aspect of a nurse case manager's job but it is not the primary function. A Master in Nursing Case Management can put the MSN graduate in charge of a clinical unit or a hospital ward; in some respects the job is similar to the advocacy role played by the Clinical Nurse Leader.
A graduate in this specialty will receive training in nurse informatics which is today the source of so much case material for individual patients. Case management may also involve working with families and spouses, explaining the complexities of treatment or working out whatever authorization may be required to complete a treatment protocol. The Masters in Nursing Case Management is a degree that reflects the continuing development of a massive processing structure for medical treatment of all kinds and the methods by which it is conducted. Multiple medical specialists may provide sections of a diagnostic process, information may flow to the case records from multiple labs and clinics, and the case manager may be called upon to ensure that all recommendations are met.