The nurse case manager's goal is to provide the highest quality care using a variety of resources at the least cost. To reach these goals, the case manager has to be concerned not only with the individual patient, but also the patient's family, the local medical community, available resources, as well as insurance coverage and benefits. Workers'compensation case management focuses on returning the injured worker to work as quickly as possible since the direct and indirect costs of a claim can be high for an employer. The employer is paying not only for the medical and wage replacement benefits, but for lost productivity. The nurse case manager is usually the liaison between the injured worker, employer, claim representative, physician, and often the attorney representing the injured worker.
Insurance carriers use nurse case managers in a variety of ways in workers'compensation.
The carrier may have its own nurse employees or hire a managed care organization to provide these services. Case management services are provided either telephonically or on-site. The Telephonic Nurse Case Manager Typically the telephonic nurse obtains a medical history and current status of the injured worker, the physician's treatment plan, the employee's regular job duties, and a modified duty program, if one is in place. A call is made to the claim representative to provide an educated estimate regarding the anticipated length of disability, and any suggestions the nurse may have regarding the treatment plan. During the time between office visits, the nurse may make many calls to obtain the medical reports for review.