Case Management Focus: Know How to Show Your Value as a Workers’ Compensation Nurse Case Manager

18 Jun, 2024 Anne Llewellyn

                               

Sarasota, FL (WorkersCompensation.com) -- Nurse Case Managers are in a unique position to ensure the cases they work on stay on track and meet the injured worker's needs so they can return to gainful employment as soon as they are medically stable. In this article, I wanted to share how so tips I have used to show my value and achieve successful outcomes.  

  • Work closely with all providers to keep the lines of communication open between all stakeholders.  
  • Break down payment barriers by working with the claims adjustor to make payments promptly. 
  • Get rates approved and how to submit payment, especially if the provider is new to the workers' compensation network or is out of network. 
  • Help the patient follow the plan of care outlined by the doctor. By working with the injured worker and providers, the case manager can ensure the injured worker knows their role and participates in the best way they can. If problems arise, find out the root cause and address it in a timely manner. Keeping the team updated as to challenges is essential. 
  • Having a good network of case managers can help you find providers who work well with the injured worker. Your colleagues can point you in the right direction, especially if you need to become more familiar with the providers in the area where your patients live. This is especially true for those doing telephonic case management. 
  • By working with other case managers, you can find the best of the best, know who to call to make timely appointments and address barriers as they arise.  
  • Move the case forward by ensuring timely diagnostic testing and the return of the films and reports to the ordering provider. 
  • Have a follow-up appointment ready so the injured worker can see the provider as soon as possible. If further testing is needed or a specialist is needed, the nurse case manager can coordinate promptly.  
  • When asking about returning the injured worker to work, talk to the employer and obtain a job description of the type of work the employer can provide.  
  • Prepare the injured worker so they are in the loop and not surprised when this is brought up. 
  • Have the information the physician needs to decide on return to work.  
  • Check-in often with the injured worker and the employer to make sure things are going well. If barriers arise, address them as best you can.  
  • In your documentation, note why it is important for you to stay involved throughout the case and the value you are bringing.  

The goal for a nurse manager in a worker's compensation claim is to assist the injured worker in returning to gainful employment. Your reports should detail your work to make this happen with the original employer or a new one.  

I would like to know how you show value in the cases you work. Email me examples of your successes, and I will use them in another article.  


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    About The Author

    • Anne Llewellyn

      Anne Llewellyn is a registered nurse with over forty years of experience in critical care, risk management, case management, patient advocacy, healthcare publications and training and development. Anne has been a leader in the area of Patient Advocacy since 2010. She was a Founding member of the Patient Advocate Certification Board and is currently serving on the National Association of Health Care Advocacy. Anne writes a weekly Blog, Nurse Advocate to share stories and events that will educate and empower people be better prepared when they enter the healthcare system.

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