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Nurse Case Manager Chronicles
The Power of a Job Description: Cut Claim Time and Prevent Reinjury
Even when you’re doing everything possible for an injured worker, a successful return-to-work transition can be jeopardized when a treating physician isn’t attuned to the ins and outs of the worker’s job.
“It’s helpful for physicians to know the demands for a position,” said Trish Elizalde, a branch manager for Genex Services. Elizalde served as a case manager for 10 years.
“A job description helps a doctor visualize what the worker does on the job and it helps physicians facilitate return-to-work decisions that help get injured workers back to the jobsite while keeping them safe from reinjury.”
Playing an integral role in the healing process, physicians assess injured workers’ impairment, create treatment plans and administer care where needed. They also provide employers and other third parties with updated information on the worker’s progress.
If they lack the knowledge and understanding of a particular job, they could keep a worker at home unnecessarily, delaying the healing process. Worse, they might send a worker back to the grind too soon — the perfect recipe for a second serious injury and prolonged recovery.
It’s in the Details
It may seem like a small piece to the overall claims puzzle, but “job descriptions are huge,” said Elizalde.
By knowing what an injured worker does day-in and day-out, from lifting requirements to frequency of tasks, a physician is better suited to set restrictions while introducing an injured worker back to their job.
Trish Elizalde, branch manager, Genex Services
“An accurate job description assists the treating physician in making decisions about whether an injured worker is able to return to work in any capacity,” she said. “They welcome this information.”
A seasoned case manager, Elizalde said that nurse case managers (NCMs) gather this vital information from employers before conducting site evaluations, breaking down the physical aspects of a worker’s job.
“We strive to obtain a job description on every case. [Case managers] know the right questions to ask and what the physicians are looking for in terms of the physical demands of a position.”
Through this information, the hope is to gain enough insight to maximize and speed recovery. A thorough job description answers how much weight is lifted, how often and for how long. Do employees lift objects from the floor? Is it to waist height or overhead? How far does an employee carry an object, and do they use the assistance of a lifting device?
In addition to lifting, the form documents how long an employee sits or stands, if they bend or squat, or climb stairs or ladders.
“Most of our case managers have safety hats and boots in their car. They’re prepared for anything.” — Trish Elizalde, branch manager, Genex Services
“Some activities might be observed once while others might be observed over a longer period of time,” Elizalde said. “We estimate what percentage of their workday is engaged in a particular activity. We note if they worked with machinery, hand-held tools, operated motor vehicles or if they were indoors or outdoors in varying temperatures.
“The extent of the details we gather is to provide the best physical description of the job to ensure the injured worker’s safe return to work and to avoid further injury or exacerbate the current injury.”
Sometimes, however, the employer is hesitant to provide information.
“Employers want to know why we’re doing this,” she said. “Their biggest concerns are security and safety issues.”
Time constraint is the most common reason why an employer may not have a job description handy for a case manager, said Elizalde. And she understands why: “Employers are very busy, but we are finding that employers are becoming more engaged, and we appreciate that.”
There are also employers, she said, who understand the importance of an accurate job description and the value that it adds to a workers’ compensation program. These employers have “invested time to establish a bank or database of job descriptions,” over time.
Elizalde added, “Our case managers certainly try to provide information to employers about how job descriptions are used by physicians to make return-to-work decisions. If we feel the job description is incomplete or if there are questions regarding an aspect of the position, we contact the employer to ask additional questions or suggest an onsite visit.”
During a site visit, NCMs conduct an evaluation of an injured worker’s job requirements. They may speak with others doing similar tasks to see what the injured employee might be doing upon returning to work. Elizalde called this the “parts of the job not talked about” — that is,
minúte details of a position that aren’t included in a broad job description.
However, said Elizalde, having a case manager enter an active construction site or power plant — where there is high risk of injury due to heavy machinery — can set employers on edge, with safety becoming a concern once again.
But getting in and getting that job description is vital to the process.
“Most of our case managers have safety hats and boots in their car. They’re prepared for anything,” she said.
Return to Work
Through the job description, physicians can learn the aspects of a job. Workers are often asked to review job descriptions submitted to their physicians as well, guaranteeing accuracy.
In addition to getting feedback from the injured worker, NCMs make sure they are communicating with the employer during the road to recovery. Case managers work with the physician and employer to find temporary or partial duty tasks that injured workers can perform until they are ready to return fully recovered.
“We want to get the [injured worker] out of their house, get them moving, get them back to normal.” Elizalde said. “Some employers don’t even know that they can bring back a worker on modified duty.”
Much like the information NCMs provide to an adjuster, she said, case managers will update the employer on their worker’s status to keep them engaged in the claims process.
“We find that when an employer is engaged in the comp process, employees have better results. We’re happy to lend our expertise to assist employers in creating a job description when one is not available, as well.” &
