What Is a Case Manager in Healthcare and Can They Help You Save Money?
Key takeaways:
A case manager is often a nurse or social worker who coordinates and manages your care.
Case managers can help you save money by making sure you get appropriate and cost-effective care. They can also help you avoid going to the hospital or emergency room unnecessarily.
Whether it’s searching for affordable healthcare alternatives, such as generic medications, or negotiating for lower-cost services, case managers are skilled at helping you reduce your out-of-pocket expenses.
Finding ways to save money on healthcare can be challenging. But your healthcare team can help provide guidance and support.
For instance, you can talk to your primary care provider about telemedicine visits, which may cost less than in-office appointments. You can also talk to your pharmacist about drug savings programs in addition to using prescription discounts from GoodRx. And there’s another healthcare team member you should know about who can help you save: case managers.
Case managers go by a few different titles, such as care coordinators and patient advocates. But no matter what they’re called, their job is to help guide you through the healthcare system.
What are medical case managers?
Case managers are usually nurses or social workers who help families and caregivers through the healthcare journey. They can serve as your guide and advocate to ensure that you receive the best possible care.
One of the key advantages of having a case manager is that they can find ways for you to save money. They can help you look at alternative care options that may be more affordable. They can also connect you with programs that provide financial assistance or discounts on healthcare services.
What does a case manager do?
A case manager’s primary responsibility is ensuring that everyone on the healthcare team is doing their part to restore you back to health. They coordinate medical care and provide support and education. They also make sure you receive services that are appropriate and cost-effective.
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Let’s say you are admitted to the hospital and diagnosed with cancer. A hospital case manager might step in to ensure a smooth transition from the hospital to the next phase of your cancer care. The hospital case manager may also work with you and your family to arrange home health care or long-term care.
Some health insurance companies have case managers available, too. In this case, when you leave the hospital, your health insurance case manager can help you coordinate with the cancer-care team. For example, they can help you schedule appointments, tests, and procedures. They can also help you understand your insurance coverage and assist with getting a prior authorization for your treatment.
In addition, your case manager can connect you with counseling services or support groups to help you cope with the cancer diagnosis.
Case managers can work in different settings and help people in slightly different ways. Here are some examples of what different types of case managers do:
Hospital case managers
If you’re hospitalized, a hospital case manager will coordinate and oversee your care while you’re there. Hospital case managers are often nurses who work closely with the medical team. They review how healthcare resources are used to ensure you receive the appropriate and necessary care.
They also communicate with your health insurance company to approve your hospital stay. As you prepare to be discharged, the hospital case manager can help set up your next steps. They might arrange for you to go to a rehabilitation facility or get home health services.
Social worker case managers
Social worker case managers often focus on helping to connect you with community resources.
For example, a social worker case manager might work with a single parent facing financial difficulties by putting them in touch with:
Local housing agencies
Employment resources
Home health case managers
You might be assigned a home health case manager if you need medical care at home. The home health case manager’s goal is to ensure you receive the appropriate health services and support while living at home.
Let’s say an older adult is discharged from the hospital but continues to need medical assistance. A home health case manager would review their needs and make arrangements for services. For instance, the older adult may need help with physical therapy, managing medications, and arranging visits from nurses.
Disability case managers
Disability case managers assist people with disabilities in getting necessary support. They may also help you with applying for government benefits.
Someone with a disability seeking employment may contact a disability case manager to get help exploring suitable job opportunities.
Behavioral health case managers
Imagine having a personal guide to support you in your mental health journey. This is what a behavioral health case manager does. They help you navigate the complexities of treatment and ensure you receive the care you need.
Behavioral health case managers work hand in hand with healthcare and mental health providers. If you’re struggling with anxiety, depression, or other mental health conditions, you may reach out to a behavioral health case manager for guidance. They might connect you with the appropriate providers and help you develop coping strategies.
Health insurance case managers
A health insurance case manager ensures you receive appropriate and cost-effective medical services. They make decisions to benefit both the patient and the insurance carrier.
Let's say you need hip replacement surgery. A health insurance case manager would review the treatment plan and work with your healthcare provider to ensure that the surgery meets your needs and is covered by your insurance policy. They may also educate you on how to care for yourself after the surgery to prevent complications.
Geriatric care managers
Geriatric care managers are usually nurses or social workers who assist older adults and their families. They can help locate resources and create a plan for the long-term care of older adults.
How can a medical case manager help me save money?
In a 2014 study, researchers examined the healthcare expenses of Medicare patients once they were discharged from the hospital. They discovered that with the assistance of case managers, these patients avoided an average of approximately $3,800 in healthcare costs during the six months after leaving the hospital.
In a 2017 study, nurse case managers were found to be effective in reducing healthcare costs for patients with heart failure.
Case managers may help you get the care you need at home to avoid the expense of going back to the hospital or emergency room. Plus, they can help you make the most of your health benefits. They can also:
Explain and compare the cost of treatment options
Search for more affordable facility options
Help you enroll in clinical trials
Find free or discounted medications
Negotiate lower fees for services you need
Look for patient assistance programs to reduce your out-of-pocket expenses.
Suggest lower-cost options if you have a high deductible
Help you find providers who are in network for your health plan
Where can I find a medical case manager?
There are several places to ask about finding a case manager:
Your healthcare provider: Begin by reaching out to your healthcare provider and ask if they have a case manager available to assist you.
Your insurance company: Some insurance companies offer case management services to their members. Call them and ask about having a case manager help you.
Hospitals and health systems: If you’re hospitalized, ask to talk to a hospital case manager or social worker. They can also connect you with an outpatient case manager after discharge.
Community nonprofits: Check with local community centers and nonprofit organizations. They often have resources or can refer you to a case manager in your area.
Government agencies: Local agencies like the Department of Social Services may have case management programs available.
Online: Use search engines to find case management services in your area. Search for keywords such as “case management services” or “care coordination” along with your location.
Private case management services: You can also hire a case manager from a private company, but you will have to pay for their services out of pocket. For example, geriatric care managers charge anywhere from $90 to $250 an hour.
How can I work with a case manager for free?
If you’re not assigned a case manager by the facility or organization that’s overseeing your care, ask if they have one on staff. If they do, find out if you qualify for their services. If they don’t, ask if there’s someone available through social services in your area, or talk to your health insurance company about being assigned a case manager.
The bottom line
Case managers are healthcare professionals who also play the role of patient advocates. They can help you achieve the best possible outcomes for your health while cutting down on healthcare costs. With a case manager by your side, you can get helpful advice and support while saving money on healthcare.
Why trust our experts?
References
American Case Management Association. (2020). Case management: Standards of practice & scope of services.
Arya, D. K. (2020). Case management, care-coordination and casework in community mental health services. Asian Journal of Psychiatry.
Case Management Society of America. (n.d.). What Is a case manager?
Gardner, R., et al. (2014). Is implementation of the care transitions intervention associated with cost avoidance after hospital discharge? Journal of General Internal Medicine.
Joo, J. Y., et al. (2017). Case management effectiveness in reducing hospital use: A systematic review. International Nursing Review.
Lukersmith, M., et al. (2016). What is case management? A scoping and mapping review. International Journal of Integrated Care.
Moroch, B. (2022). Geriatric care managers advocate for older adults — and their caregivers. AARP.
Van Spall, H. G. C., et al. (2017). Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: a systematic review and network meta-analysis. European Journal of Heart Failure.
Wang, N., et al. (2022). The effectiveness of case management for cancer patients: an umbrella review. BMC Health Services Research.
