In order to get the best return on investment an employer or claims adjuster should seek out a nurse case manager possessing qualities which make them best suited to manage their claims in the field. Any good nurse case manager should be:
In addition to the seven listed qualities, other desirable qualities for a nurse case manager are: flexibility, excellent written and oral communication skills, and multi-task oriented.
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“The 6-Step Process To Determine Workers’ Comp Injury Causation”
7 Desirable Nurse Case Manager Qualities
1. Available– Nurse Case Managers should be available to attend appointments. The employer and claims adjuster should also be able to reach the nurse by email or cell phone so that urgent issues can be addressed quickly.
2. Experienced– If a nurse is new to workers’ compensation case management, look for experience in managed care, discharge planning, or occupational health.
3. Certification-Â There are several certifications for case managers; the most common is CCM (Certified Case Manager). This certification insures that the individual has been able to meet standards set forth for the industry and is required to obtain continuing education in the area of case management each year.
4. Expertise in ortho/neuro/occ– med-Since most injuries received on the job involve these areas, a nurse with expertise in these same areas will improve your return on investment by anticipating the treatment and outcomes in advance.
5. Willingness to– become familiar with the worksite-Any nurse case manager you use should be willing to go to the worksite and be familiar with the equipment, layout, and areas of concern. The nurse should be willing to meet with the employer and obtain specific information about the job.
6. Familiar with– state specific WC laws-Nurses are not expected to be attorneys, but any nurse case manager should be familiar with maximum TTD and PPD rates as well as mileage and waiting period requirements.
7. Able to direct- the claimant to their claims adjuster or state commission for additional information when necessary.
If you get the same information from the nurse case manager you can get by making a few calls, it is time to get a new case manager. If you are not getting quality information from your nurse case manager, visit this list and see what you are missing.
Victoria Powell is the President of VP Medical Consulting, LLC located in Central Arkansas. VP Medical Consulting is a nurse consulting firm providing services to employers, insurance companies, attorneys and the general public. Services include case management, life care planning, legal nurse consulting, ergonomics and patient advocacy. Ms. Powell holds specialty certifications in a variety of nursing specialties. She can be reached through the web at http://www.vp-medical.com by phone at 501-778-3378. We are accepting short articles* (300-800 words) on WC cost containment.
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.
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