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Changes in the healthcare environment provide the impetus to look closely at the way in which patient care is delivered. Complex health problems, requiring the expertise of multiple healthcare specialists, coupled with complex hospital systems, result in fragmented care that is confusing to patients and their families. Case management by nurses working closely with physicians in hospitals is one strategy that can reduce fragmentation of care. Case management also facilitates the delivery of cost-effective, patient-focused care. Because of his/her expertise, the clinical nurse specialist (CNS) is an ideal choice for the role of case manager. The authors describe the role transition of nurses from CNS to CNS/case manager over a 2-year period and identify the key system supports required to ensure successful evolution into this expanded role.