What is a case manager?
The Case Management Society of America defines a case
manager as a health care professional who is responsible for utilizing the case
management process for individuals with health-related needs, with the goal of
maximizing their wellness, autonomy and appropriate use of resources.
What experience do case managers have?Nurse Case Managers are registered nurses with at least 10 years of nursing experience. Many nurses have advanced degrees and have specialized clinical skills and knowledge. In addition, many nurses have national certification from organizations which focus on case management. These include CCM, CRRN, and CDMS. Continuing education is required to maintain professional licenses and national certifications.
Nurse Case Managers who work in the workers’ compensation
environment generally have backgrounds in orthopedics, neurology, critical
care, emergency trauma, general surgery, rehabilitation, or occupational
health.
Exactly what is it that nurse case managers do?
Case Managers have several roles – they are advocates, facilitators, coordinators and educators. The foremost role is advocate. Whenever a case manager works with an injured worker, the nurse establishes a relationship with that person. The case manager and injured worker establish goals and plans to meet those goals. While working as a case manager in workers’ comp it is essential that the case manager inform the injured workers that any information related to the claim and its outcome will be shared with the physician(s), claims representative, and employer.
Exactly what is it that nurse case managers do?
Case Managers have several roles – they are advocates, facilitators, coordinators and educators. The foremost role is advocate. Whenever a case manager works with an injured worker, the nurse establishes a relationship with that person. The case manager and injured worker establish goals and plans to meet those goals. While working as a case manager in workers’ comp it is essential that the case manager inform the injured workers that any information related to the claim and its outcome will be shared with the physician(s), claims representative, and employer.
How can employers maximize the benefits of case managers?
Collaboration is the key to a successful outcome with a case manager. Case managers are looking for a win-win situation – the injured workers returns to wellness and the employer regains a productive employee. Although the case manager will be an expert about the injury and treatment, he or she may not be an expert about the injured worker’s job and specific requirements. Share a detailed job description with the case manager. This will foster understanding about your business. This knowledge and a written job description helps the case manager to clearly discuss how the injured worker can safely return to work during recovery from the work injury. Use the case manager’s medical knowledge to help design a job around any restrictions the physician may order. Ask questions about the treatment plan – how long will treatment last, are there other effective treatments.
Collaboration is the key to a successful outcome with a case manager. Case managers are looking for a win-win situation – the injured workers returns to wellness and the employer regains a productive employee. Although the case manager will be an expert about the injury and treatment, he or she may not be an expert about the injured worker’s job and specific requirements. Share a detailed job description with the case manager. This will foster understanding about your business. This knowledge and a written job description helps the case manager to clearly discuss how the injured worker can safely return to work during recovery from the work injury. Use the case manager’s medical knowledge to help design a job around any restrictions the physician may order. Ask questions about the treatment plan – how long will treatment last, are there other effective treatments.
Case managers are NOT the "claims police"
Injured workers (and some mistaken employers) may think that the case manager is assigned as a policeman. Nothing can be further from the truth. Medical care is becoming more and more complex. The case manager will assist the injured worker to understand the treatment plan, medications, and why early return to work is essential for a full recovery.
Injured workers (and some mistaken employers) may think that the case manager is assigned as a policeman. Nothing can be further from the truth. Medical care is becoming more and more complex. The case manager will assist the injured worker to understand the treatment plan, medications, and why early return to work is essential for a full recovery.
Because the case manager brings medical expertise to the claim,
he or she will always be pushing toward the next outcome and goal. Expect the case manager to provide
suggestions and recommendations for next steps.
Through education and experience, a case manager brings medical
expertise to the claim. A case manager
also helps to coordinate care with a variety of healthcare providers—physicians, therapists,
pharmacists, etc. Case Managers are not
“claims police”. Their only focus is on
returning injured workers to wellness through appropriate medical care. As nurses, case managers are advocates for the injured worker, which benefits the injured worker and the employer. Thank you to Nancy for sharing her experience and insight on some of the many aspects of case management!
