Role of the Nurse Case Manager in Workers Compensation Claims

The goal of the Nurse Case Manager (NCM) is to assist the injured employee and facilitate the employee’s return to work through the identification of the medical services needed, the arrangement for those services to be provided, to advocate for the employee’s medical needs through communication with all medical providers, and to educate the employee on the employee’s role in the recovery process.

The NCM can be employed by the workers’ compensation insurance carrier, the self-insured employer, the third party administrator or by the medical provider, such as an orthopedist. For the purpose of this blog, we will review the role of the NCM from the perspective of the workers’ comp insurance carrier.

The title of Nurse Case Manager is the most frequently used name for the role, but like workers’ comp adjusters are sometimes referred to as claim examiners, there are other names for the NCM. In some insurance companies the role is referred to as the “workers compensation case manager” or “injury management facilitator” or “field case manager” (FCM) if most of the work is done away from the office, or “telephonic case manager” (TCM) if the work is done in the office by using the telephone.

Note: These are NOT the same as NURSE TRIAGE which is when a claim is reported directly to an RN for suggestions about initial medical treatment.