Nurse Case Management Overview

If you’ve ever felt lost or confused trying to manage a workers’ comp claim, imagine the added stress of a serious injury or long-term illness. At Approach, our full-time Nurse Case Manager (NCM) is ready to help with serious cases so that everyone involved — the employer, injured worker, and family members — has a better understanding of what’s happened and the next steps to take.

When it comes to workplace injuries and illness, there are two main types of cases in which the NCM will assist: severe injuries and long-term recoveries. Let’s take a look at the main ways in which our NCM, who is a registered nurse, assists with these types of cases:

Serious injuries

Our crisis response team at Approach, notifies our NCM directly about a serious accident or injury. (Approach clients can activate our crisis team 24/7 by calling 206-812-3850). It’s always helpful for her to be notified and involved as soon as possible.

1. Employer – this is usually the first point of contact and can happen by phone or at the hospital. The NCM will ask for:
   1. The events of the accident, as you know them
   2. Contact information for the injured worker’s family. It is important to let the family know to expect a call from an NCM.
2. The Family – this should happen as soon as possible, but with sensitivity to their needs. If possible, an employer representative should join the NCM as she assists the family with:
   1. Understanding what they have been told by the doctors, social workers and nurses.
   2. Navigating the hospital and city.
   3. Transitioning from hospital to home, including the transition from hospital-based providers to local ones.
   4. Maintaining contact upon discharge
3. Medical Team – In most cases, the family must allow the NCM to speak with the medical team and will be present for these meetings. These meetings are hard to coordinate during hospitalization and can be easier to arrange with local providers after discharge.
4. Post-Discharge – The NCM can follow this case through to discharge from medical care and return to work, working with medical professionals, vocational counsellors, and others along the way.

Long-term recovery   

Nurse Case Management can be vital when it comes to recoveries that are complex or just not progressing as expected. Your claim might be a good candidate for Nurse Case Management if you’ve noticed any of the following:

• Early complex medical challenges
• Sporadic, but frequent missed time from work that has not been certified by the medical provider
• Prolonged light duty with no increase in physical abilities
• Unchanged complaints with no change in treatment plan
• No objective medical findings, but worker has not returned to work and continues to receive time-loss
• New or increasing diagnoses

Your Approach Retro Coordinator is continually monitoring your claims to identify if Nurse Case Management is needed.

There can be legitimate reasons for any of these situations. The NCM has the training and experience to either explain them to you as an employer or get an explanation from the doctor or doctor’s representative. Of course, the NCM can also help move the treatment plan forward in cases where there’s not a justified reason for issues that are slowing recovery.

As with so many valued medical providers, we hope that you and your employees don’t need the services of our NCM. However, it’s always good to know that she is available as part of the services provided to Approach clients. Contact your retro coordinator with any questions or if you have a claim that might be suited for an NCM review.