Work Comp Case Managers: A Complex Role

photo credit: Josh Liba

The most important role of the case manager is to advocate while educating. Case managers must advocate on the client’s behalf to get each client the right resources and the right care at the right time and by the right provider–all while considering the patient’s own resources and abilities. Clients need to understand the information they have been given and the implications for their future, while learning how to manage and navigate the landscape on their own. The workers compensation patient has an additional learning curve as they navigate the legal system and employment issues all while recovering from an injury.

 

Jo Carter, a Commissioner with CCMC explains, “The workers’ compensation setting is a highly regulated area of practice, with both health care regulations to follow and state-by-state reimbursement systems and laws. When you’re providing case management services, you have to be aware of how those regulations affect the process. There is also the interdependence of many other stakeholders, including attorneys–an attorney who may be giving the worker specific advice based not necessarily on returning them back to health and the highest level of independent function, but on the legal and financial aspects of the claim. That can create conflicting goals and dynamics. There can be additional pull for case managers who are employees of the insurance company in workers’ compensation cases. Their struggle is to advocate for the client while evaluating for fraud and abuse. With all these factors in play, it’s not surprising that the workers’ compensation industry has much more experience using case management and has led the way in identification of ethical dilemmas and state regulations that require case manager certification to manage these complex cases.”

 

In order to be a successful case manager working within the confines of the workers compensation arena, one must possess a distinct knowledge and skill set.  The nurse case manager should be a master communicator, negotiator and facilitator, as well as technologically savvy enough to maximize time; working smarter within the confines of the clock.  Here at VP Medical Consulting, we do not want nurses who can simply attend an appointment and report back the findings.  We want nurses who are engaged, critical thinkers, and able to think outside the box.  Our nurses must be willing to stand on their principles and rally for what the patient needs while functioning within the confines of the payor source.  Our nurses are either certified by CCMC or are working toward certification.

 

If you need an experienced workers compensation case manager, consider VP Medical Consulting.

 

Related articles

• CMSA Salutes Case Managers and Encourages Celebration of National Case Management Week (prweb.com)
• Personal injury is not the same as a workers compensation claim (injuredworkerslawfirm.wordpress.com)