Best Use of Nurse Case Managers

Nurse case managers can vastly improve outcomes for injured workers and save a bundle for payers. The trick is to understand which claims will benefit from intervention and to use nurses with the right skill set.

“If an injury occurs from lifting equipment or falling from a height, the claim needs a nurse,” said Stephanie Perilli, senior director of medical and health management for The Home Depot, during a session at the National Workers’ Compensation and Disability Conference® & Expo on November 12.

In a comparison of claims more than 24 months old, the company saw a 12 percent savings on paid medical dollars and a 28 percent reduction on paid loss dollars for claims with nurse involvement.

For non-catastrophic cases, the company uses a model to determine whether to involve a nurse.

“Our results have significantly improved over the last three years,” she said.

In a comparison of claims more than 24 months old, the company saw a 12 percent savings on paid medical dollars and a 28 percent reduction on paid loss dollars for claims with nurse involvement.

But not every claim is appropriate for nurse intervention. A recent study determined that 25 variables, especially when some are in combination, can serve as triggers.

“If you’ve got an injured worker who is over 35, has no college degree, has injured a certain body part and undergone certain medical treatment, get a nurse as soon as possible,” said Mary O’Donoghue, VP of medical services for Helmsman Management Services.

In addition to the complexity of a claim, the nurse’s skill set can determine the value of involvement. Those nurses who are trustworthy can make the most difference.

“They can identify problems, educate folks, and redirect where needed,” O’Donoghue said.

Helmsman has found the most effective soft skills needed to move claims forward are communication with all parties involved, including family members; empathy, to establish trust with the injured worker; and collaboration, to make sure there is a plan in place and everyone involved is on the same page.