Q&A: The licensed versus non-licensed case manager

November 1, 2017
Medicare Web

Q: What's the distinction between the case manager and non-lincensed case manager extender?

A: Non-licensed case manager extender, patient navigator, and health coach are terms that may be used to describe the nonlicensed member of the interdisciplinary team serving and working in the population health model. For the purpose of our discussion, the role is described as the non-licensed case manager extender, but different organizations may have different titles and different job descriptions.

The Case Management Society of America (CMSA) states that case management is a collaborative process. However, CMSA is clear that only the licensed professional case manager is able to complete the following six components of the case management process: 

  • “Client identification, selection, and engagement in professional case management
  • Assessment and opportunity identification
  • Development of the case management plan of care
  • Implementation and coordination of the case management plan of care
  • Monitoring and evaluation of the case management plan of care
  • Closure of the professional case management services” 

The professional case manager is responsible for supervising and delegating duties to the non-licensed case manager extender. The professional case manager is practicing under a license and the CMSA Case Management Standards of Practice. The non-licensed case manager extender is not. The assistant is limited in what he or she may do for the patient, and it is the responsibility of the case manager to make certain the assistant is not operating outside of the case manager’s delegation and oversight. 

The non-licensed case manager extender is a valuable team member; however, the professional case manager is responsible for the assistant’s activities and must take this responsibility seriously. The professional case manager and non-licensed case manager extender relationship is a valuable partnership that will enhance the population health model. The partnership will promote patient engagement and activation and produce quality individual and population health outcomes. Nevertheless, the case manager through responsible delegation, supervision, and oversight will ensure patient safety and protect the professional case management practice.

The case manager holds a license in nursing, social work, vocational rehabilitation, or another healthcare discipline. He or she is educated and trained in the many components of case management. 

Finally, the case manager sits for an evidence-based certification exam, only after completing at least one year in case management practice. After completing and passing the exam, the case manager is a licensed professional and certified case manager. 

The distinction between the non-licensed case manager extender and the licensed professional certified case manager is significant. However, the non-licensed case manager extender provides support to the case management process and contributes to the case manager’s plan for both the individual patient and for a large group of patients found in a population health model.


For more information, see Case Management Guide to Population Health: Management Across the Continuum of Care.

Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered.