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Nurse Case Manager Chronicles

The Case Manager’s Many Hats

Nurse case managers act as a resource of knowledge, assistance and support for injured workers and everyone involved in their care.
By: | March 26, 2018 • 4 min read

Do you know what your nurse case manager does? Sure, on the surface it’s easy to know the job description — a registered nurse who coordinates all aspects of care for injured workers — but what exactly is a nurse case manager doing each day to help injured workers, save insurers money and keep workers’ compensation claims out of court?

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The answer: They’re wearing many hats. Mediator, moderator, educator, negotiator and expert.

“Nothing is the same from day to day,” said Chikita Mann, a registered nurse and the Georgia branch supervisor for Genex Services, which specializes in medical management. “The most challenging part is working with a number of different personalities.”

A case manager spends their day speaking with doctors, employers, workers, adjusters, insurers and attorneys. That nurse is the go-to person for knowledge and the go-between for each step of the workers’ comp claim.

Knowing People

“I can be very blunt and straightforward sometimes,” Mann said. “I have learned to adapt my own behavior to each person I interact with. No matter the personality, everyone wants to know they are being heard and they have something to contribute to a situation.”

When a worker gets injured, different agendas can cause stress and strife.

Chikita Mann, RN, Georgia branch supervisor, Genex Services

An employer aims to get their worker back on their feet while juggling the workers’ comp claim and their other employees. The injured worker faces confusion about their medical needs while trying to heal from their injury and provide for their family. The carrier reviews the incident, deciding if it’s a compensable injury or not.

The nurse case manager’s job is to keep everyone updated and on task. The nurse educates injured workers on proper care, mediates between the employer and their worker, moderates the physician’s care plan, and negotiates with the employer and insurer to get the best care outcome while saving costs.

“The one thing I hear most is ‘I did not understand how serious this was until I had a conversation with the case manager,’” said Mann. “It’s not just about getting workers back to work; it’s about getting them to the best of their health so they can have a full life.”

An injured worker once called Mann with a complaint about his nurse case manager. He didn’t understand why he needed someone from the medical field who wasn’t his physician on his workers’ comp case.

Mann responded, saying she heard his concern and would like to address it head on. She put on her educator hat, prepared to help the worker understand the nurse’s role, but before they could sit down to talk, the worker called back.

“He said he jumped the gun. He was unaware of what exactly the nurse could do for him, which ended up being beyond his expectations,” said Mann. The worker had a series of comorbidities that pre-dated his injury, and the nurse case manager saw to it that those illnesses were addressed alongside his injury.

But it isn’t always that easy; while some underestimate the nurse case manager’s role, others expect more. If Mann sees tempers starting to rise, her first instinct is to review the case file and ask what is expected of the nurse.

“Sometimes, there is an expectation that the case manager can acquire information about non-work-related medical issues,” Mann said. “However, we are unable to secure this information without a signed medical release from the injured worker.”

“No matter the personality, everyone wants to know they are being heard and they have something to contribute to a situation.” — Chikita Mann, RN, Georgia branch supervisor, Genex Services

Mann explained that a hospital has no legal obligation to “hand over” a worker’s medical records, and the NCM is not able to demand the records be released. Both the hospital and a case manager need to abide by HIPAA.

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“Some states have specific laws on what a case manager can and cannot do,” said Mann. “For instance, in Georgia the injured worker and their attorney have to be copied on all correspondence, like reports or letters. It’s not an option — it is mandatory.”

Some employers, according to Mann, may feel that if something is related to their worker’s comp claim, the employer should be copied on correspondence as well, but that’s not always the case.

Keeping It All on Track

Maintaining knowledge that is both broad-based and highly specific, and carefully balancing the interests of all parties is all business as usual for highly focused NCMs.

“Workers’ comp case managing is challenging, because it requires knowledge from other case managing areas. We have to know workers’ comp jurisdiction and guidelines. We have to know about any comorbidities [in the patient],” said Mann.

“Field case managers need to understand a hospital’s discharge process. Sometimes they need to know how to utilize social work skills, serving as liaisons between different institutions and case parties to assist patients and collaborate with other health professionals.

“It’s structured flexibility,” Mann continued, using a term she coined. “There is a set way of doing case management, however a nurse needs flexibility to adapt to the scenario at hand.” &

Autumn Heisler is digital producer and staff writer at Risk & Insurance. She can be reached at [email protected]

More from Risk & Insurance

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Risk Management

The Profession: Curt Gross

This director of risk management sees cyber, IP and reputation risks as evolving threats, but more formal education may make emerging risk professionals better prepared.
By: | June 1, 2018 • 4 min read

R&I: What was your first job?

My first non-professional job was working at Burger King in high school. I learned some valuable life lessons there.

R&I: How did you come to work in risk management?

After taking some accounting classes in high school, I originally thought I wanted to be an accountant. After working on a few Widgets Inc. projects in college, I figured out that wasn’t what I really wanted to do. Risk management found me. The rest is history. Looking back, I am pleased with how things worked out.

R&I: What is the risk management community doing right?

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I think we do a nice job on post graduate education. I think the ARM and CPCU designations give credibility to the profession. Plus, formal college risk management degrees are becoming more popular these days. I know The University of Akron just launched a new risk management bachelor’s program in the fall of 2017 within the business school.

R&I: What could the risk management community be doing a better job of?

I think we could do a better job with streamlining certificates of insurance or, better yet, evaluating if they are even necessary. It just seems to me that there is a significant amount of time and expense around generating certificates. There has to be a more efficient way.

R&I: What was the best location and year for the RIMS conference and why?

Selfishly, I prefer a destination with a direct flight when possible. RIMS does a nice job of selecting various locations throughout the country. It is a big job to successfully pull off a conference of that size.

Curt Gross, Director of Risk Management, Parker Hannifin Corp.

R&I: What’s been the biggest change in the risk management and insurance industry since you’ve been in it?

Definitely the change in nontraditional property & casualty exposures such as intellectual property and reputational risk. Those exposures existed way back when but in different ways. As computer networks become more and more connected and news travels at a more rapid pace, it just amplifies these types of exposures. Sometimes we have to think like the perpetrator, which can be difficult to do.

R&I: What emerging commercial risk most concerns you?

I hate to sound cliché — it’s quite the buzz these days — but I would have to say cyber. It’s such a complex risk involving nontraditional players and motives. Definitely a challenging exposure to get your arms around. Unfortunately, I don’t think we’ll really know the true exposure until there is more claim development.

R&I: What insurance carrier do you have the highest opinion of?

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Our captive insurance company. I’ve been fortunate to work for several companies with a captive, each one with a different operating objective. I view a captive as an essential tool for a successful risk management program.

R&I: Who is your mentor and why?

I can’t point to just one. I have and continue to be lucky to work for really good managers throughout my career. Each one has taken the time and interest to develop me as a professional. I certainly haven’t arrived yet and welcome feedback to continue to try to be the best I can be every day.

R&I: What have you accomplished that you are proudest of?

I would like to think I have and continue to bring meaningful value to my company. However, I would have to say my family is my proudest accomplishment.

R&I: What is your favorite book or movie?

Favorite movie is definitely “Good Will Hunting.”

R&I: What’s the best restaurant you’ve ever eaten at?

Tough question to narrow down. If my wife ran a restaurant, it would be hers. We try to have dinner as a family as much as possible. If I had to pick one restaurant though, I would say Fire Food & Drink in Cleveland, Ohio. Chef Katz is a culinary genius.

R&I: What is the most unusual/interesting place you have ever visited?

The Grand Canyon. It is just so vast. A close second is Stonehenge.

R&I: What is the riskiest activity you ever engaged in?

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A few, actually. Up until a few years ago, I owned a sport bike (motorcycle). Of course, I wore the proper gear, took a safety course and read a motorcycle safety book. Also, I have taken a few laps in a NASCAR [race car] around Daytona International Speedway at 180 mph. Most recently, trying to ride my daughter’s skateboard.

R&I: If the world has a modern hero, who is it and why?

The Dalai Lama. A world full of compassion, tolerance and patience and free of discrimination, racism and violence, while perhaps idealistic, sounds like a wonderful place to me.

R&I: What about this work do you find the most fulfilling or rewarding?

I really enjoy the company I work for and my role, because I get the opportunity to work with various functions. For example, while mostly finance, I get to interact with legal, human resources, employee health and safety, to name a few.

R&I: What do your friends and family think you do?

I asked my son. He said, “Risk management and insurance.” (He’s had the benefit of bring-your-kid-to-work day.)

Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]