In workers’ compensation, nurse case managers (NCMs) perform many tasks. They work with medical providers, employers, and injured workers to facilitate appropriate medical services, identify potential obstacles to recovery, and ultimately focus on returning injured employees back to work.

To control medical costs, NCMs often work with other managed care services, such as provider networks and utilization review. If a diagnosis or treatment is inappropriate, NCMs will help to get the employee’s treatment plan back on track by working with providers and claims adjusters.

In these roles, NCMS have expressed three key needs to help them do their jobs more effectively:

1. Help me identify quality providers. Many work-related injuries seem simple in nature, but they have the potential to become long and costly if complications are not addressed early. In addition, injuries may require diverse medical services from various types of providers.
   
   In these scenarios, NCMs want an easy and effective way to identify the best providers in various areas of medicine. Although they may have access to large general networks, it may be difficult to identify the quality doctors in a given field. When good physicians have been identified, nurses are still tasked with the process of scheduling appointments, and coordinating an appropriate time and location with the patient.
   
   One Call Medical (OCM) specializes in providing assistance for scheduling various types of diagnostic tests. We have established a network of quality providers for both advanced radiology and electrodiagnostic services. If payers partner with OCM, their nurses can offload the entire diagnostic referral process—no longer having to worry about identifying a provider, scheduling an appointment, or following up on the medical report or bill. One Call Medical handles the whole process, offering online tools to streamline the process even further.

 

2. Help me return injured employees back to work. Today, many nurse case managers are being held accountable for returning employees back to work as soon as possible. Working with providers, NCMs develop a return-to-work (RTW) plan that takes the employee’s job responsibilities and work restrictions into account.
   
   To do this effectively, nurses rely on accurate diagnostic information to guide an appropriate and effective treatment plan, which aids in a speedy recovery and RTW. However, studies show that key diagnostic exams, known as Electromyography (EMG) and Nerve Conduction Studies (NCS), are often performed by unqualified providers. As a result, as much as 68 percent of these tests may not be medically useful. A poorly performed test or inaccurate test interpretation can derail a patient’s entire treatment plan, leading to unnecessary or inappropriate medical services, delays in recovery, and extended disability.
   
   One Call Medical is the only company with a network of qualified EMG and NCS providers (neurologists and physiatrists exclusively), selected and credentialed using AANEM quality guidelines and an evidence-based approach that continually monitors the quality of its providers. When payers partner with OCM, their nurses receive the most accurate diagnostic information to guide diagnosis, treatment, and RTW.

 

3. Help me to obtain additional education and CEUs. Most states require that nurse case managers receive licensed certification to practice, as well as a certain number of continuing education units (CEU) each year to maintain their license. In addition, NCMs must be knowledgeable about workers’ compensation laws in the states they serve, as this expertise helps them to appropriately manage a claimant’s medical care and RTW outcomes in manner compliant with statutory requirements.
   
   By offering courses, payers can provide NCMs with a valuable opportunity to upgrade their skills and expertise, while also assisting them in meeting state-mandated CEU requirements.
   
   To address these needs, One Call Medical has launched a series of free webinars and continuing education units (CEUs) that help NCMs to understand today’s complex medical, diagnostic, and workers’ compensation issues. These training opportunities are free and available online through OCM University. To view a calendar of events and register for classes, please visit http://www.onecallmedical.com/OCMUniversity.aspx or contact One Call Medical at the information below.

Give them what they need!

NCMs are adept at collaboration and multi-taking. On a daily basis, they communicate workers’ compensation objectives and expectations to a large number of stakeholders. Today, they’re under intense pressure to manage the timeframe in which injured workers receive medical treatment, recover, and return to work. In this process, they juggle multiple objectives in terms of patient advocacy, cost control, and quality care.

Yet, they do it all with a compassionate and proactive approach, understanding that if the patient wins, we all win. With this growing plate of responsibilities, however, it’s vital to provide your NCMs with the services, tools, and education they need to perform their jobs to an optimal level of success.

For more information on how to provide your NCMs with access to OCM’s quality diagnostic providers, scheduling services, or the free educational opportunities discussed in this article, please contact:

Bill Colacurcio
Phone: 973-316-3718
Email: bill_colacurcio@onecallmedical.com