Nurse Case Management-Best Practices

Time Management

Adjuster Contacts

·        Sort contacts to adjuster by name and/or customer

·        Make calls/faxes to adjuster at a time when they are most accessible (early am or according to customer preferences)

·        Contacts with adjuster should be chronological and concise.  Questions and information should pertain on to the injury (i.e.: RTW, Tx plan, Dx, findings, nurse case management plan)

·        If communication with adjuster is by fax only, place all information that effects the direction of the case in bold face type

·        Request that adjusters return calls/faxes within a specified timeframe in order to keep the case moving.  If an adjuster does not respond, attempt a second contact by the same communication method in approximately 2 business days (unless the priority demands more aggressive follow-up)

·        Place the adjuster’s name, number and goal of the next contact in the activity portion of the next diary so it is easily acceptable.

Provider Contacts

·        Request telephonic information for 4 elements:  MD objective/subjective findings, injury diagnosis, treatment plan to include testing, therapy, surgery and work status.  Always ask about estimated return to work if client is not working.

·        Allow providers to return calls at a time convenient for them.  Many providers will leave information on a voice mail if you leave a specific request and advise them of the confidentiality.

·        If a provider will provide information only in writing, document this in your case notes and request that information to be faxed if possible.

·        If a provider refuses to give any information, use other methods of persuasion with the provider (letter of representation, verbiage relaying that cooperating with the case manager could expedite authorization for necessary treatment, ask the client to contact the provider’s office on your behalf). If all else fails you may contact the adjuster regarding the difficulty and ask that a letter be sent on your behalf or contact the client’s attorney (if they have one) and ask them to contact the MD office on your behalf or if they prefer, all medical information be sent to them and then forwarded to you (the case manager) in a timely manner.

·        Type while talking on the phone.  Put phone number in notes for easy accessibility when making the next call.

·        If you are having trouble getting return to work (RTW) information from the provider, try “we need this information regarding RTW so we know whether the injured worker needs another disability payment”.

Injured Worker Contacts

·        Manage the conversation with the injured worker around the injury, the response to treatment, and the work status. 

·        Assume you can contact the injured worker unless the injured worker or his attorney state you cannot.

 

Prioritize Daily Activities

 

·        Diary a case only one time per day

·        Use on activity to diary all contact for one case on one day

·        Balance daily workload throughout the work week

·        Attention the calls you are behind on first

 

Documentation

 

·         Use only approved abbreviations

·         Make sure your notes are clear

·         Request telephonic information on cases.  Written information should only be obtained if there is provider non-compliance.  Written confirmation is necessary only for post office visits, RTW slips, treatment or diagnostic orders

·         Identify provider specialty in every case notation

·         Identify all individuals spoke with by name and title

·         If you have received written reports, document (in your notes or update to adjuster) only the pertinent findings and treatment plan, not the entire report

·         Do not keep paper files of your case work

·         Refer to yourself as this consultant or I in the notes.  Do not use first person to refer to others.

·         Mark all faxed, emailed or overnight mailed notes as “sent”