• Menu
  • Skip to main content
  • Skip to secondary navigation
  • Skip to primary sidebar
  • Skip to footer

Before Header

  • About
  • Contact
  • Privacy
 
Paradigm

Amaxx Workers Comp Blog

Reduce Workers Compensation Costs By 20-50%

Header Right

  • Home
    • Training Center
  • Search
    • Free Resources & Solutions
    • Subscribe to Free Newsletter
    • Create Free Training Center Account
    • Enroll in On-Demand Courses
    • Activate WC Mastery Membership
    • Request Strategic Coaching Session
    • Buy WC Guidebooks
  • Membership
    • Insider (free account)
    • WC Mastery
    • Teams & Managers Mastery
    • Training Partners
  • Products
    • On-Demand Courses
    • Specialty Courses
    • Certifications & Mastery Courses
    • Ultimate Guidebooks
    • Coaching
  • Blog
    • Video Blogs
    • COVID-19 / Coronavirus Pandemic
  • Login

Mobile Menu

  • Home
    • Training Center
  • Search
    • Free Resources & Solutions
    • Subscribe to Free Newsletter
    • Create Free Training Center Account
    • Enroll in On-Demand Courses
    • Activate WC Mastery Membership
    • Request Strategic Coaching Session
    • Buy WC Guidebooks
  • Membership
    • Insider (free account)
    • WC Mastery
    • Teams & Managers Mastery
    • Training Partners
  • Products
    • On-Demand Courses
    • Specialty Courses
    • Certifications & Mastery Courses
    • Ultimate Guidebooks
    • Coaching
  • Blog
    • Video Blogs
    • COVID-19 / Coronavirus Pandemic
  • Login
  • About
  • Contact
  • Privacy
You are here: Home / Medical & Pharmacy Management / 6 Triggers for When, And When NOT to Use Nurse Case Managers

6 Triggers for When, And When NOT to Use Nurse Case Managers

November 12, 2018 By //  by Michael B. Stack

when to use nurse case management Nurse case managers are a hot topic in workers’ compensation, and with good reason. Used properly, they can generate great results for organizations in getting injured workers back to work as soon as possible and saving precious dollars for organizations. But there is often misunderstanding about how and when to use Nurse Case Managers. For example:

  • Should you use a Nurse Case Manager on every workers’ compensation claim?
    • No
  • If a Nurse Case Manager is used, should it be for the entire duration of the claims process?
    • No
  • Is there a difference in telephonic vs. field Nurse Case Managers?
    • Yes

Nurse Case Managers can reduce litigation rates, foster patient engagement in the recovery process, and provide vital communication among all stakeholders. They can also be a waste of money and add little value

Click Link to Access Free PDF Download

“The 6-Step Process To Determine Workers’ Comp Injury Causation”

Understanding when and how to use Nurse Case Managers is key to getting the best bang for the buck.

What They Can Do

Research showing the potential value of Nurse Case Managers has resulted in some companies using them on every single claim from beginning to end. Many of these companies then wonder why they are spending so much money without seeing a return on investment, so they discontinue using Nurse Case Managers altogether. Both are a mistake.

Here are some of the many ways Nurse Case Managers can help on a workers’ compensation claim:

  • Advocate and educate. The best reason to use a NCM is to help an injured worker who is frightened, confused and angry — often a recipe for litigation. The NCM can educate and advocate for the injured worker and guide him through the entire process, so he knows what to expect. The NCM can also inform employers on how the injured worker is progressing, and work with the treating physician to make sure the worker is getting appropriate care.
  • Flag potential problems. If the injured worker has psychosocial or pain management issues or needs durable medical equipment, the NCM can spot that early in the claims process and help coordinate the necessary treatment.
  • Communicate with all stakeholders. The NCM can keep everyone in the loop, so necessary details don’t fall through the cracks.

When to Use Nurse Case Managers

Simple, medical-only, and claims where the injured worker is highly engaged and anxious to return to full duty as quickly as possible do not signal the need for a NCM. On these and other cases the addition of a case manager is unnecessary and a waste of money.

More complex claims are where Nurse Case Managers can have a significant impact. Certain claims should trigger involvement from a NCM, including:

  1. Lost time. Workers who are off the job for more than a couple of days can benefit from extra involvement. A NCM can answer the injured worker’s questions and ensure he is complying with the treatment plan.
  1. Surgery is needed. Even if it is a medical-only claim, the need for surgery should be a red flag to get a NCM on the claim. There will be many things going on, such as preparing at home, the need for and type of pain medications after, and any DME that might be temporarily needed. The NCM can coordinate the various moving parts.
  1. Failing to attend scheduled medical appointments. Whether the worker is off the job or working in some capacity, failing to see treating physicians, physical therapists and other providers is a sign there may be a problem. A NCM can contact the injured worker and either get the person to comply or find out if there is an underlying problem that should be addressed.
  1. Comorbid Conditions. An injured worker with diabetes, obesity, hypertension or other comorbid conditions is prime for a more complicated claim. A NCM can help keep the claim on track.
  2. Uncooperative treating physician. If the injured worker’s primary physician continues to say the patient needs to stay out of work entirely, a NCM can intervene, find out why the person is not recovering, and explain return-to-work principles — such as light duty and employer accommodations.
  3. Catastrophic and/or multiple injuries. These claims involve many people and moving parts. A NCM can be the go-to person for all parties involved, including the injured worker and his family. The NCM can also make any arrangements needed, and keep costs down by selecting the most appropriate equipment.

    FREE DOWNLOAD: “The 6-Step Process To Determine Workers’ Comp Injury Causation”

When to End NCM Involvement

Putting a NCM on a claim doesn’t need to be a long-term prospect. These can be short assignments — even just one or two visits or calls. Depending on the complexity of the claim and ongoing issues, the NCM may need to contact the injured one time to keep him on track and in compliance with medical appointments; or may need to reach out to the treating physician for something simple; or discuss accommodation possibilities with the employer. The earlier a NCM intervenes in a claim, the shorter the assignment typically is.

You can gauge when the NCM is no longer needed, for example:

  • The injured worker is back to work in at least a light duty capacity
  • Stakeholders are communicating well with one another
  • Restrictions are decreased, and the worker is progressing well

Conclusion

Nurse Case Managers can add tremendous value to a claim, generating optimal outcomes for injured workers and lower costs for payers. But it is not a black and white issue; meaning they don’t need to intervene in every single case, and they don’t need to be involved indefinitely. Thinking through a strategy for using Nurse Case Managers can have a significant impact on claims.

Michael Stack - Amaxx

 

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

FREE DOWNLOAD: “The 6-Step Process To Determine Workers’ Comp Injury Causation”

 

Filed Under: Medical & Pharmacy Management

Related Articles

Field Nurse Case Manager

Reducing Work Comp Costs With Field Nurse Case Managers

Reducing Work Comp Costs With Field Nurse Case Managers

Unnecessary IMEs Cost Your Program Money

Unnecessary IMEs Cost Your Program Money
Prescription Drug Abuse

Opioid Study Highlights Effective Use and Dangers

Opioid Study Highlights Effective Use and Dangers

Tools to Combating Pharmacy Spend in Workers’ Compensation

Tools to Combating Pharmacy Spend in Workers’ Compensation

Direct Healthcare to Reduce Work Comp Costs

Direct Healthcare to Reduce Work Comp Costs

Paradigm Appoints Chris Pricco as CEO of Specialty Networks

Paradigm Appoints Chris Pricco as CEO of Specialty Networks

Ambulatory Surgery Centers vs. Hospital Outpatient Departments. Which Is Better?

Ambulatory Surgery Centers vs. Hospital Outpatient Departments. Which Is Better?
Leverage Specialty Pharmacy Services in Complex Workers’ Comp Claims

Using Prescription Drug Formularies to Manage Work Comp Costs

Using Prescription Drug Formularies to Manage Work Comp Costs

Is Coronavirus Compensable in Workers’ Compensation?

Is Coronavirus Compensable in Workers’ Compensation?

Prescription Drug Formularies to Reduce Workers’ Comp Costs

Prescription Drug Formularies to Reduce Workers’ Comp Costs

Defending Medical Marijuana Claims

Defending Medical Marijuana Claims

What is Medical Cannabis?

What is Medical Cannabis?

Train to Succeed

BECOME CERTIFIED IN WORKERS’ COMPENSATION

Proven Course Catalog & WC Toolbox Give You The Power To Achieve Lower Costs and Better Injured Worker Outcomes

VISIT WORKERS' COMP TRAINING CENTER

Free Download

The 6-Step Process To Determine Workers' Comp Injury Causation - FREE Download Click Here Now!

Previous Post: « 18 Items in Your Work Comp Adjuster’s Three-Point Contact
Next Post: 8 Steps For A Staffing Agency to Reduce Workers Comp Costs »

Primary Sidebar

FREE DOWNLOAD

The 6-Step Process To Determine Workers' Comp Injury Causation - FREE Download Click Here Now!

Our Sponsors

Catastrophic and Risk Solutions, Case Management Solutions, and Specialty Networks
 

Medcor

Injury Triage, Onsite Clinics
 

ARCADIA - Enhancing Settlement Outcomes

The Structured Settlements Company
 

MSAs, Section 111 Audits, & Conditional Payment Resolutions

Post-Settlement Administration

Read Our Award-Winning Blog

Blog Categories

Search Our Archive

Subscribe to Our FREE Newsletter

Return-to-Work Essentials

Footer

Search Our Archive

Search our continually growing archive of over 2500 articles about Workers' Comp issues.

Quiclinks

  • Calculators
  • Terms & Abbreviations
  • Glossary of WC Premium Terms
  • WC Resources
  • Best Practices
  • Industries
  • Return-to-Work Essentials

RSS Recent Blog Posts

  • MSP Manual Update Puts MSAs into Motion at Provider Level
  • Know Your Correct Job Classification Codes To Save Workers’ Comp Costs
  • Reducing Work Comp Costs With Field Nurse Case Managers
SUBSCRIBE TO OUR FEE NEWSLETTER
Let Us Help You Stomp Down the High Cost of Workers' Comp!
Top of Page ↑
  • Home
  • Training Center
  • Search
  • Membership
  • Products
  • Blog
  • About
  • Contact
  • Subscribe
  • Login
Copyright © 2023 Amaxx, LLC. All Rights Reserved. · Privacy Policy / Legal Notice