Case Manager

A Case Manager is a Registered Nurse with expertise in all areas of nursing. A Case Manager is a consultant to assist you in returning injured employees back to work, saving you costs in medical treatment and off work pay, and assists the injured person in obtaining the best medical treatment for their injury.

When an employee is injured at work, the employer turns that injury in to the workers compensation insurance company. If that injured person misses any work, the insurance company has to pay them for being off work, after a short waiting period. The employer either requests a nurse or the Insurance Adjuster decides a nurse is needed to:

Consult with the employer or adjuster to determine which type of doctor would best treat that particular injury and what doctor's are in that area.

I recommend different doctors if the current doctor is not doing what I feel he should be doing to get the injured employee well.

Meet the injured employee and take a detailed medical and personal history

Call the doctor and get copies of all medical records pertaining to that injury

Review the records and give the adjuster or employer my opinion of the treatment plan and how long I think this person should be off work. I also use a medical book that gives normal healing times for injuries.

Attend all the doctors' appointments with the patient and get written work status and progress notes.

Schedule all tests, therapies, doctor appointments, home health, equipment etc.

Keep the employer and insurance adjuster updated on everything that goes on

Get approval from adjusters for all tests, surgeries and treatments

Schedule all physical therapy and call them several times a week to be sure the patient is coming and doing what they are suppose to be doing.

Get all medical records, from tests, physical therapy and others, make copies and present information to the doctor at every visit

Work with the employer to see if they will accommodate any type of work

Sometimes go to the work place to see what the patient does so I can explain it to the doctor

Call the patient several times a week to be sure they are ok and doing all the treatment orders

Change appointments if needed, call doctor if anything else is needed

Keep patients' attorneys updated if they have one. I get permission from attorneys to continue to work with the patient since once the patient hires an attorney; the insurance adjuster is not able to speak to the patient.

If a doctor recommends surgery and I do not feel surgery is warranted from reading all medical reports and discussing surgery with that doctor, I will recommend a second opinion with another doctor of the same specialty and schedule it.

I discuss the treatment with the doctors and make recommendations to the doctor and also ask him to explain treatment that I do not feel should or should not be occurring.

If the patient does not complete the recommended treatment plan, I inform the employer and the insurance adjuster and that patient's compensation (money and treatment) can be halted or interrupted by the insurance adjuster until the patient is compliant with the treatment plan.

I write letters to doctors asking for explanations of treatment and proof of the injury if treatment is taking too long or if the injury could possibly be preexisting the work incident.

A detailed report is written by me on everything that has happened with that patient for the month and the report is sent to the insurance adjuster. Copies can also be sent to the employer and attorney's if requested.

Letters are sent to the patients about all their appointments, any changes in treatment and to explain the case managers role in their treatment course.

Hiring a nurse saves the companies money because the nurse makes sure the doctors appointments are scheduled on time, with no delays or lapses, physical therapy is started as soon as possible, surgeries are scheduled as soon as possible and the patient is returned to work much sooner than without a nurse.

Cost Savings can be estimated at the close of every claim, if requested.


	Case Manager Checklist : Do you need CCM to assist you on your workers compensation claims? A Case Manager is a Registered Nurse with expertise in all areas of nursing. A Case Manager is a consultant to assist you in returning injured employees back to work, saving you costs in medical treatment and off work pay, and assists the injured person in obtaining the best medical treatment for their injury. Here is what I do as a Nurse Case Manager: When an employee is injured at work, the employer turns that injury in to the workers compensation insurance company. If that injured person misses any work, the insurance company has to pay them for being off work, after a short waiting period. The employer either requests a nurse or the Insurance Adjuster decides a nurse is needed to: Consult with the employer or adjuster to determine which type of doctor would best treat that particular injury and what doctor's are in that area. I recommend different doctors if the current doctor is not doing what I feel he should be doing to get the injured employee well. Meet the injured employee and take a detailed medical and personal history Call the doctor and get copies of all medical records pertaining to that injury Review the records and give the adjuster or employer my opinion of the treatment plan and how long I think this person should be off work. I also use a medical book that gives normal healing times for injuries. Attend all the doctors' appointments with the patient and get written work status and progress notes. Continue to get all medical records as they are completed Schedule all tests, therapies, doctor appointments, home health, equipment etc. Keep the employer and insurance adjuster updated on everything that goes on Get approval from adjusters for all tests, surgeries and treatments Schedule all physical therapy and call them several times a week to be sure the patient is coming and doing what they are suppose to be doing. Get all medical records, from tests, physical therapy and others, make copies and present information to the doctor at every visit Work with the employer to see if they will accommodate any type of work Present work options to the doctor Sometimes go to the work place to see what the patient does so I can explain it to the doctor Call the patient several times a week to be sure they are ok and doing all the treatment orders Change appointments if needed, call doctor if anything else is needed Keep patients' attorneys updated if they have one. I get permission from attorneys to continue to work with the patient since once the patient hires an attorney; the insurance adjuster is not able to speak to the patient. If a doctor recommends surgery and I do not feel surgery is warranted from reading all medical reports and discussing surgery with that doctor, I will recommend a second opinion with another doctor of the same specialty and schedule it. I discuss the treatment with the doctors and make recommendations to the doctor and also ask him to explain treatment that I do not feel should or should not be occurring. If the patient does not complete the recommended treatment plan, I inform the employer and the insurance adjuster and that patient's compensation (money and treatment) can be halted or interrupted by the insurance adjuster until the patient is compliant with the treatment plan. I write letters to doctors asking for explanations of treatment and proof of the injury if treatment is taking too long or if the injury could possibly be preexisting the work incident. A detailed report is written by me on everything that has happened with that patient for the month and the report is sent to the insurance adjuster. Copies can also be sent to the employer and attorney's if requested. Letters are sent to the patients about all their appointments, any changes in treatment and to explain the case managers role in their treatment course. Hiring a nurse saves the companies money because the nurse makes sure the doctors appointments are scheduled on time, with no delays or lapses, physical therapy is started as soon as possible, surgeries are scheduled as soon as possible and the patient is returned to work much sooner than without a nurse. Cost Savings can be estimated at the close of every claim, if requested. Complete Case Management, Inc. \| home Resume References Services Guidelines Activities Case Manager Arkansas Business Article Personal Referral Legal Nurse Consulting Arkansas Links