National Case Management Week is October 11 – 17, 2020
The theme this year for National Case Management Week is Case Managers Can _______________.
Our Case Managers were asked to write their thoughts on this sentence. Below are Janet Platz RN. QMA, CCM’s thoughts.
Case Managers Can Be Compared to the Hub of a Wheel Connected to Each Spoke.
The Case Manager plays a unique role in the insurance industry, particularly, as it is specific to each state’s WC system. The Case Manager can be likened to the hub of a wheel connected to each spoke, and makes the wheel go forward. The Case Manager is the “eyes and ears for the Claims Adjuster, develops rapport with the Claims Adjuster, and never loses sight of that fact that the Claims Adjuster “owns” the claim.
Education is Key
The Case Manager as necessary educates the Claims Adjuster regarding certain medical related information and terms, which facilitates the progress of the claim. The Case Manager provides significant and routine written and verbal updates to the Claims Adjuster on an ongoing basis and perseveres in obtaining this information. The Case Manager collaborates with the Claims Adjuster in specialist referrals and direction of care.
The Case Manager fulfills client needs by facilitating the provision of cost-effective care without sacrificing quality of care.
The Case Manager develops special rapport and credibility with the Recovering Worker, by “being there”, i.e., being directly available by phone, answering calls and using voicemail only as necessary; returning phone calls promptly; maintaining follow up on the dates agreed upon and as necessary; and assisting the Recovering Worker in communicating concerns to the physician.
In Represented cases when permission for Case Manager contact is given by the applicant attorney, the Case Manager is the only party outside of providers that has direct access to the Recovering Worker.
The Case Manager establishes and maintains consistent contact with the treating and consulting physician(s) and facilitates obtaining copies of medical reports.
Yes, a WC Case Manager is especially unique! And so are you, Janet. Thanks for sharing.