Remote case managers provide essential education and care coordination for patients with new or ongoing health needs. Case managers are also known as nurse navigators, care managers, or care coordinators.
A remote case manager might work with patients after a workplace injury, multiple emergency room visits, or repeated hospital admissions.
Others work with patients who have complex diagnoses like cancer, stroke, or mental health disorders. Still others focus on patients preparing for a scheduled procedure or planning for discharge. Some work completely at home while others blend remote work with in-person visits.
This article will provide an inside look at case management, including direct quotes from remote case managers in many different position types. This article will answer questions about case management, including:
- What does a remote case manager do?
- Where do case managers work?
- A day in the life as a remote case manager
- What background and experience is required to become a case manager?
- Case manager certifications
- Interview tips for case managers
- Salary range for case managers
- Pros and cons of case management
What does a remote care/case manager do?
Case managers coordinate care for patients with new or complex health needs.
This position requires exemplary patient education skills as well as a strong grounding in basic med-surg nursing. A remote case manager will spend the majority of the workday speaking to patients over the phone, documenting on the computer, and reaching out to specialists.
In many ways, case management provides a bridge between social work and bedside nursing. Remote case managers help patients access resources, understand and safely administer their medications, and prepare or recover from procedures or hospital admissions.
A typical patient caseload might include:
- Pre-admission patients: have you completed your pre-admission testing and labwork? Do you have someone who can drive you home and stay with you during recovery? Are you familiar with your post-discharge care plan? Do you understand pre-operative diet requirements?
- Post-surgical patients: how is your pain? Are you able to attend your post-operative visits? How is your diet and bowel movements? Can you access your medications? Do you have an adequate support system for recovery?
- Patients with frequent admissions: do you have transportation for preventative healthcare visits? Can you afford your daily medications? Do you need resources for making lifestyle changes that can help you stay healthy and safe? How is your mental health?
- Patients with complex health needs: Do you understand your healthcare plan? Do you need help making follow-up appointments with specialists? Do you need a referral for hospice, social work, or behavioral health? Do you have a support system at home? Do you need help with logistics, like transportation or meals?
|“I am a worker’s compensation case manager and work out of my home office. I work both remotely and in the field. Some of my cases are in my geographical region, and I attend appointments with the injured worker. I also have files where I coordinate care for injured workers telephonically. I see a range of injuries, some simple sprains or strains, and catastrophic injuries like traumas or crush injuries. My day consists of communication (phone, text, email, video conference, in-person, fax, letter) with claims adjusters, injured workers, physicians, healthcare staff, medical facilities, therapy providers, DMEs, vendors, imaging, interpreters, attorneys, and employers. I have files in multiple states and time zones. I coordinate care, follow up on authorizations, educate all involved parties, obtain medical records, discuss injured workers’ return to work, expected recovery, treatment options, expedite processes, ensure correct documents are completed/received/forwarded and provide recommendations. I document all activity for the file. Also, I report on current treatments and status.”|
Who hires them?
Many remote case managers work for insurance companies like Medicaid, United Healthcare, Cigna, Blue Cross Blue Shield, and Humana. Others might work for a hospital system or specialty clinic for patients with specific health needs such as fertility, mental health, or cancer.
Potential employers include:
- Insurance Companies
- Long-term care facilities
- Hospital organizations
- Hospice and palliative care
- Community and public health centers
- Outpatient clinics
- Specialty clinics for oncology, fertility, or behavioral health
- Home health
- Government agencies
Remote case managers employed by insurance companies might work with patients to access resources for affordable medications, connect patients to mental health resources, or help patients find a support group for their chronic condition.
|“I start and end my day with team meetings, usually 20-30 minutes, but if it’s busy maybe an hour for either. I review my caseload with peers & supervisors. I then conduct virtual visits with medically complex kids & their families, which takes up most of my day with 2 or 3 hour-long visits per day. Often there is a family support specialist (social work or chaplain) on the call with me. We discuss recent medical appointments or changes, how they feel about that, what they like about their current lifestyle and what they want to change, then we brainstorm about options that would work for the family. A lot of times it’s just check-ins, making sure that things are going smoothly. The rest of my day is spent charting, calling/emailing providers to coordinate care/recommend changes the family requested, and coordinating with my team.”|
Case managers for hospital systems or specialty clinics may provide education in preparation for an upcoming procedure or help connect patients to resources to manage an ongoing condition. They may also work directly with insurance companies to ensure that patients receive care that is medically necessary and that care will be reimbursed by the insurance company.
Some remote case managers do not provide any direct care, while others blend remote work with home visits or in-office visits with local clients.
|“I handle high-risk maternity Medicaid members. We recently took on NICU babies. Members are identified through doctors and positive pregnancy tests notification. Members are screened by vendors, and if they are high-risk, I follow up and talk to the members about our program. If members choose to enroll, I help answer questions and provide resources such as information on pregnancy topics, housing, food pantries, rides to appointments, and other benefits like breast pumps, dental, vision, behavioral health, and healthy rewards (points that they earn going to doctor appointments that gain rewards like baby gear and visa gift cards). I then follow up monthly with the members and talk to them at least twice during the postpartum period.”|
Day in the life as a remote case manager
Most case management positions require their nurses to work a standard, 8-5 work schedule. A typical day starts by logging into the company system and reviewing your cases for the day.
After you are familiar with the patients and cases assigned for the day, you begin making calls. When a patient answers, you review patient goals, answer questions, or provide education about upcoming procedures or medication changes.
If needed, you will provide referrals to resources like social work or behavioral health. Depending on the employer, you may also connect patients to resources to help pay for medications or access safe transportation to appointments.
|“As soon as the authorization comes through I make outreach to members who are in the hospital or in a facility for mental health or substance abuse diagnosis. This usually consists of leaving them a voicemail because they cannot have their phones while in a facility. About a week later I call the facility and speak with the discharge planner. See if they need any assistance with discharge planning. Once the member is discharged, I receive the discharge summary from the facility. I then make 2-3 more outreach attempts to the member. This is to check in, see if they have any insurance questions, make sure they can pay for and pick up medications, and make sure they have transportation to appointments. If they don’t have any aftercare set up, I can refer them to a therapist or psychiatrist. Help them identify a support person and a crisis plan. If they need a referral to a specific type of Case Manager (pharmacy, RD, child/adolescent, SW, BHSW, pregnancy, diabetes), I can make that referral. Call aftercare appointments to verify they attended. If they did not then ask the member why and troubleshoot how we can help to get them to an appointment.”|
All patient interactions are documented electronically. Remote case managers may also need to send information directly to the patient to reinforce teaching. There may also be team meetings, trainings, or interdisciplinary calls with care teams.
Due to the set hours, this job usually requires employees to take PTO for personal needs like dentist appointments or sick kids at home.
This position usually requires multiple nursing licenses in order to provide care to patients across the United States.
|“Patients were from all over the US. I had eleven different licenses in addition to my compact nursing license, but my employer paid for the licenses and the continuing education credits needed to maintain these. At one point, I wondered ‘how many times do I have to get my fingerprints taken…’”|
Required background and experience for remote case managers
Case management requires a broad knowledge of the most common chronic conditions that may affect individuals in need of case management, including diabetes, cancer, heart disease, and stroke. In addition, case managers should be familiar with common medications involved in these chronic conditions.
Most importantly, case managers need to have experience with patient education. A case manager is frequently required to educate patients about medication use, pre- and post-operative care, and lifestyle changes. This type of experience can be acquired through bedside nursing in areas like med-surg, PACU nursing, the emergency room, or intensive care nursing.
Most case management positions require 3-5 years of experience as a bedside nurse. This level of experience ensures that a case manager has the depth and breadth to provide adequate teaching to their patients.
|“You need your assessment skills, and you need to know a little bit about everything. There are so many different diagnoses that you’re dealing with. There are tons of medications, and you need to understand those medications because you need to educate patients about them.”|
Case manager certifications
Case managers with a few years of experience may choose to acquire additional certifications. These certifications can lead to increased job opportunities, career advancement, or potentially higher salaries.
The main certification opportunities for case managers includes:
- Certified Case Manager: The CCM is offered through The Commission for Case Management Certification. In order to sit for the exam, you must have 12-24 months of case management experience.
- Nurse Case Manager Certification: The CMGT-BC is offered through the American Nurses Credentialing Center. To sit for the exam, you must have two years of experience as a registered nurse, at least 2,000 hours of clinical practice in nursing case management within the last 3 years, and 30 hours of continuing education in nursing case management within the last 3 years.
- American Case Management Certification: The ACM is provided by the American Case Management Association (ACMA). The exam is open to Registered Nurses and Registered Social Workers with at least 2080 hours of supervised, paid work experience as a case manager.
Interview tips for remote case managers
There are many opportunities available for nurses interested in remote case management.
When preparing for interviews, it’s important to remember the basics of patient assessment, common diseases and medications, and patient education skills. Previous bedside experience is the biggest asset for new case managers.
Since case management requires so much patient interaction, these interviews commonly include behavioral interview questions.
There are other ways to stand out as a case manager candidate. Consider researching key case management topics, like:
- InterQual Criteria: a decision-making tool for making healthcare care plans
- Milliman Care Guidelines: a set of guidelines for appropriate care across specialties
- Standards of Practice for Case Management: guidance specifically for case managers to provide consistent, evidence-based care coordination
Most employers will provide in-depth training on case management principles and standards of care for nurses who are new to this role. However, it’s helpful to understand the basic terminology and guidelines to demonstrate your preparation and knowledge of the industry.
|“If you are done with the craziness of the floor or patient care, if you’re burned out, this is a different type of job because you’re not on your feet all day. It’s a different pace. If you like engaging with your patients, this is a great job, It’s a lot of talking and a lot of education.”|
What is the average salary for remote case management?
Most case management positions are salaried. Salary depends on years of experience, certification, location, and the employer.
The average salary for case managers is $88,028 with a typical range of between $80,494 and $97,069, according to Salary.com.
Remote case managers may also consider other perks like savings on gas, transportation, and work clothing. Time savings due to the lack of commute may also be a benefit.
Pros and cons of working as a remote case manager
Remote case management is a great fit for nurses who love patient education and who want to transition away from bedside nursing.
Some of the pros of this career include:
- No weekends or on-call schedules
- Saving on gas money
- Working in sweatpants with access to your kitchen for snacks
- The opportunity to build long-term relationships with patients
- The chance to address the root causes of health barriers
- Satisfaction from helping patients reach their health goals
- A chance to recover from the burnout of bedside nursing
|“Each day looks different, which is why I love my job. I get to make my own schedule as long as I am meeting my metrics. I schedule my home visits according to my schedule. As long as I work my 40 hours every week I have the flexibility to work any hours that are reasonable. Some of my days consist of just phone calls to new referrals or ongoing cases. And other days look like home visits all day and other days can look like a combination of the two. I help my patients by connecting them with community resources, ensuring they have/are receiving needed medical / development care like well-child checks, immunizations, developmental screenings, therapies, etc. I also work regularly with DSS in regards to our at-risk population.”|
Remote case management isn’t the right fit for everyone, though. Some remote case managers mentioned that this work often requires intense and at times redundant documentation.
It can also be challenging to manage family responsibilities while working as a remote case manager. One case manager reported challenges with simply being available for daily trips to the bus stop to pick up elementary kids after school since it can be difficult to predict how long calls would last.
|“You can’t predict who is going to answer the phone. There are weeks when all I did was leave messages. Then one month I had 48 engagements. All calls are monitored with spot checks from your manager, and there are criteria they look through to make sure you hit all your points.”|
Some potential challenges of this career include:
- Conventional hours mean that you need to take PTO for obligations like doctor appointments or family responsibilities
- Potential blurring of home and work life
- Extensive time on the phone
- Rigorous documentation requirements
Remote case management is an exciting career opportunity for nurses looking for an alternative to bedside nursing but who still want regular patient interactions.
If you’re interested in exploring remote case management opportunities, check out the Nurse Fern job board.
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