ALERT-Aggressive Case Management

ALERT is an acronym which describes the process of aggressive case management.  It is not additional information that is required to be documented in the case.  This process should be completed on every verbal encounter to ensure consistent, high quality customer service. 

ALERT ensures aggressive return to work and promotion of an active treatment plan.  The nurse’s recommendations establish an appropriate plan of action and proactive recommendations.  The file is managed by utilizing established criteria, goal setting and timely communication.

First the nurse assesses the return to work plan and treatment plan by asking the following questions:

•   Did I compare the treatment plan with criteria?
•   Do subjective and objective findings match the diagnosis given?
•   Do subjective and objective findings gel with the treatment plan proposed?
•   Did I question, probe, and challenge the treatment plan?
•   Did I compare the work status with criteria?
•   Do the subject and objective findings match the return to work status/recommendations?
•   If totally disabled, why?  Is it appropriate?
•   If partially disabled, why?  Is it appropriate?
•  What are the injured worker’s capabilities?
•  What can she/he do?
•  Have I discussed light, modified duty?

The case manager then formulates a clear direction.   She maintains control of the case while giving the account assistance in making his/her claim decision.  The emphasis is the “big picture” and not just one episode of care.

The case manager formulates her plan of action by asking herself the following questions:

•   Was I aggressive in obtaining information so that I can move forward?
•   What steps do I plan to take to stay in control?
•   How do I keep my recommendations alive and achieve my case goals?

The case manager then turns her attention to comparing the treatment plan against the criteria for the injured worker’s diagnosis.  She addresses the following:

•   Have I determined within optimal criteria when this injured worker should be expected to return to work?
• Have I determined within optimal criteria when this injured worker should be expected to reach maximum medial improvement?
•  Did I update the return to work and maximum medical improvement estimates when the time frames were exceeded?
• Did I establish my own goals for return to work and maximum medical improvement when no criteria information is available?
•  Did I consult a resource to establish a goal if there was no criteria available and I was unable to establish a goal?

The next step is to review the expectations and service request from the account. 

• Does my referral source have an agenda that is somehow different from my own?
• Have I communicated any red flags that I might have encountered?
• Have I communicated in a way that is beneficial to my referral source?

The last step in the process is communication to provide all parties with the rationale for the medical information supplied so that they have a clear understanding from a medical standpoint.  All parties will understand why the recommendations are what they are and why the treatment plan is appropriate.  The case manager gives the account the rationale for the disability status.  Stating that “the injured worker is disabled and I will follow-up “, is not sufficient.  

In summary, case management is not a passive information collecting process.  The nurse case manager is an active participant utilizing the nursing process of assessment, diagnosis, outcome planning, implementation and evaluation.