Professional Nurse Case Management began at Carondelet St. Mary's Hospital 13 years ago with a goal of delivering direct nursing services to high-risk chronically III clients in the community. Nurse case management has evolved as the healthcare delivery environment has changed. This study revisits this well-described model and assesses the impact of managed care on the practice of professional nurse case management. Concept mapping was used to describe the current practice of nurse case management at Carondelet Health Network. Professional nurse case managers modeled their practice as a series of concentric spheres, each subsuming the spheres within it. Moving from the outside to the core, the spheres represent developmental framework; practicing the Carondelet mission; group practice; Integration, education, and acculturation of clients within the health system; and client-focused therapeutic relationship. One final sphere of practice, bridging the gaps, represented actions that cross all spheres of nurse case management.