The Important Role of Nurse Case Managers in Workers’ Compensation Medical Case Management

In Maryland, a "nurse case manager" is a nurse who is certified by the State Board of Nursing to provide case management services, including but not limited to interviewing the worker for the purpose of implementing and coordinating services with health care providers and with the worker and the worker's family. Medical case management is the planning and coordination of health services that lead to medical rehabilitation, whether contact with the employee is face-to-face, electronic, or written. Telephonic case managers have the same responsibilities to follow the rules as case managers working in the field. Telephonic case managers and field case managers have the same rights and responsibilities to communicate with doctors and do not function as gatherers of information or investigators. The Maryland Board of Nursing outlines the role of telephonic case managers with the expectation that they will provide medical case management in the form of an initial interview and developing and coordinating a plan of care. They are to share their notes instantaneously with parties as cases progress and ensure contact with the plaintiff's attorneys to keep them abreast of any concerns with the coordination of care.

‍Do’s and Don’ts of Nurse Case Managers

DO:

• Be cognizant of all parties involved in the medical recovery process, especially the disabled covered employee and their family. Include goals and timeframes when creating the care plan and allow for updates as needed.
• Determine what is needed for a successful return to work from both the employer and employee's perspective.
• Provide client advocacy and support at all times and provide input and guidance on treatment services. BE A LIAISON BETWEEN PARTIES, including the Commissioner/Judge.
• Educate all parties, especially the employer, whenever possible on the positive and cost-effective aspects of return to work programs and processes.
• Always obtain and maintain appropriate releases of information prior to beginning case management services.
• Understand that there are many players in the case management process, but the main client should always be the disabled covered employee; however, do not become emotionally involved with the injured worker or the case.
• Always clearly identify your role as a case manager to the employee at the start of the relationship.

DON'T

• Give legal advice at any time.
•  Withhold information crucial to RTW success.
•  Perpetuate disability by failing to address doctor recommendations, health concerns, or return to work issues in a timely fashion.
• Assume that you have an absolute right to attend all doctors' appointments despite the client's wishes against it.
•  Provide legal direction to the claims adjuster or engage in claims investigative or adversarial activities.

In summary, nurse case managers are not to function as gatherers of information or investigators and are to provide advocacy and support at all times to the injured worker, and they do not provide legal direction to the claims adjuster. Nurse case managers should not be involved with arranging independent medical evaluations to address medicolegal issues such as maximum medical improvement and permanent partial disability. Often, the evaluator is not asked all the relevant questions, resulting in additional costs for a supplemental report.