The question often looms: do I have to be a nurse to be a case manager? This is an especially common query in The Case Manager’s Community, and particularly across hospital- and health plan-based case managers. The short answer to this question is NO. However, as is typical within our case management profession, there is NO short or easy answer.

Organizational Job Descriptions vs. Established Resources of Guidance

Keep in mind the requirements defined by specific organizational job descriptions, practices, and policies and procedures may not be in sync with professional case management’s Established Resources of Guidance. These dedicated guidelines set the foundation for case management practice, and encompass state licensure boards, accreditation entities offering organizational credentialing, and credentialing bodies, employers, and professional associations. The actions of each group bolster the foundational pillars that leverage case management practice. These pillars encompass professional practice acts, codes of ethics, standards of practice, as well as employer policies and procedures. Here’s the lowdown: 

1. The first formal standards of practice for professional case management weredefined by the Case Management Society of America in 1995. The most recentversion (2022) of the standards includes a Qualifications Standard (A) that isexplicit about workforce requirements:

“The professional case manager should maintain competence in the area(s) ofpractice by having one of the following:

• A current, active, and unrestricted licensure or certification in a health or humanservices discipline which allows the professional to conduct an assessmentindependently as allowed within the discipline’s scope of practice.

• The individual who practices in a state that does not require licensure orcertification must have a baccalaureate or graduate degree in social work oranother health or human services field that promotes the physical, psychosocial,or vocational well-being of the persons being served. In addition, the degreemust be from an institution that is fully accredited by a nationally recognizededucational accreditation organization and:

• The individual must have completed a supervised field experience in casemanagement, health, or behavioral health as part of the degree requirements.

2. Organizational case management accreditation requirements vary on this topic.Neither NCQA or URAC require that case managers have specific degrees butset clear expectations for the parameters and expectations for individuals in casemanagement roles employed by each accredited organization. These standardsand guidelines are viewable at the requisite websites (NCQA and URAC).Magnet Status (through ANCC) is explicit in that case managers must be board-certified through one of two exam-based case management credentials, ANCCCertification’s Nursing Case Management credential (CMGT-BC) or CCMCCertification’s CCM. ANCC Certification’s Nursing Case Management credential (CMGT-BC) or CCMC Certification’s CCM. 

Specific to individual case management credentials, the CMGT-BC credentialing exam is only available to those persons with a nursing degree. The CCM has a more inclusive eligibility criteria, that require a “Degree and Baccalaureate or Master’s Degree from an accredited institution, in a Health or Human Services Field”. Other requirements for these credentials are viewable on each embedded website.

The Growth of Case Management Roles

There are a variety of emerging case management roles external to hospitals and health plans that exist across practice settings. Among these positions are: 

1.  Aging life care specialists (formally geriatric care managers) may be nurses, social workers, licensed professional counselors, and other behavioral health professionals. While a number of these specialized case managers are credentialed through CCMC, they may also sit for a dedicated exam-based certification, the CMC. This credential is administered by the National Academy of Certified Care Managers (NACCM).
2. A rapidly expanding workforce of case managers is being funded through Federal, state, and local government programs, as well as community-based organizations. These case managers address the complex, whole-person health of patients and their families including persons dealing with addiction, co-occurring disorders, and other types of severe mental illness. 

These case managers have diverse public health degrees across counseling, rehabilitation and vocational counseling, social work, and nursing, to name a few. They may be trained in biopsychosocial models that amplify integrated care, integrated case management, and other combined perspectives. Considerable funding is available through CMS for these population health roles at community-based organizations across community-based behavioral health programs, federally qualified health centers, community health clinics, rural health clinics, look-alikes, and other programming. 

1. Recent industry emphasis on patients and communities dealing with social determinants of health, social needs, social risks, health-related social needs, and other terms, has also increased case management roles for social workers across the industry, particularly those who have attained a BSW, but also MSWs who are licensed to practice independently, and for enhanced billing and reimbursement.
2. Keep in mind that case management is also a continuum, which starts with individuals who have human service and public health associates and baccalaureate degrees (e.g., LVNs, LPNs) as well as non-nursing professionals in roles as peer recovery specialists, community health workers, and other positions. 
3. Several states have codified the term “case management” within their practice acts. They have defined credentialing requirements with specific credentials for these roles, as in Texas and Florida. There are also grant-funded case management positions with distinct educational degrees, licensure, and credentialing requirements. The intricacies of this topic warrant greater bandwidth than this article allows for and will be the focus of a separate piece.

In the End, Case Management Competence Matters

Case management is one glorious profession that is interdisciplinary in composition and interprofessional in scope. Case management competence is not defined by one degree alone. Rather, it is measured and demonstrated by distinct education, training, expertise, knowledge, and credentialing in distinct competencies that underlie our profession. Our profession is a continuum spanning health and behavioral health academic degrees, levels of education, disciplines, and practice settings. Everyone is welcome who meets the qualifications and eligibility requirements defined by the Established Resources of Guidance. Besides, the complexity of today’s patient populations mandates the most inclusive professional case management workforce possible. Only then will organizations and the industry reap the true rewards of successful clinical and fiscal outcomes. 

More information on this topic can be found in Chapters 2 and 3 of The Ethical Case Manager: Tools and Tactics, published by Blue Bayou Press, the publishing arm of The Case Management Institute. The book is available on Amazon. 

Dr. Ellen Fink-Samnick, DBH, MSW, LCSW, ACSW, CCM, CCTP, CRP, FCM is an award-winning industry entrepreneur known as “The Ethical Compass of Case Management”. She focuses on competency-based case management, interprofessional ethics, holistic health equity, quality, and trauma-informed leadership.

Dr. Fink-Samnick is a content-developer, professional speaker, author, and educator with academic appointments at Cummings Graduate Institute of Behavioral Health Studies and George Mason University. She has served in national leadership and consultant roles across the industry. Further information is available on her LinkedIn Bio or her website