New WC CM Nurse

[cubrnjvm]

I recently started to work as a worker's comp case manager for a big insurance company. This job involves field case management which entitles attending appointments with patients that are now called clients or IW's (Injured workers), talking to physicians, medical assistants wrongly called "nurses" and at the end communicating with claims adjusters, and ancillary services to schedule and coordinate other services for your clients. I have not been doing this for long time, however was doing Home Care for a while and I thought that both fields have the main core with the visits to clients etc. with the big difference that in worker's comp you get paid, or at least you are told you are, for every minute you spend working and in home care you get paid for your visit exclusively but as everything in life nothing is perfect and I have been unable to understand the main reason why is a nurse needed in worker's comp when the work that is done is in its majority secretarial work, I do really apologize if someone gets offended, it is not my intention I have not been in this field for long may be my perceptions are wrong and that is my major concern and why writing about this topic and posting for everyone to read. Why do worker's comp companies need nurses as field case managers? Do you really believe this is a "nursing job"? Could you help me to clarify that?

[Paul B]

A great deal of the workers compensation RN position is to advocate for the patient. Even though "saving money" has been identified as a purpose of this position - it is much more a position of importance because you are meeting each claimant in their own environment, you are learning about who they are, what their work environment is like, how they relate to their "work", and how their current situation/injury has impacted their life. This position takes a great deal of skill because you are working for your employer but also your claimant, the physician(s), the rehab professionals, the adjusters, etc. Being in a position that requires such a holistic perspective demands you can be a great advocate and an expert communicator. I hope you are beginning to see this is not just a position that requires "secretarial" skills... As noted earlier, experience in this field provides more opportunity to gain wisdom and insight into the ways you can make a difference...and not merely a monetary difference. The meaning of work in a person's life is of monumental importance...keep this in mind.

[cleom925]

Thank you Paul B! Advocating for injured workers will definitely be my priority. I just need to find the perfect balance. I know it will be hard at first but as long as I know I am there to make the patient's lives better, things will fall into place. :)

[TechnoRN]

If you don't feel safe, some times you can ask for reassignment. I did home health for a few years, and the times that I didn't feel safe I felt supported to let my supervisor know that I wasn't comfortable. Trust your gut.

[chadrn65]

I did workers comp and you were only to see them at the doctor's office. There were never any home visits. I guess it depends on the company.

[cubrnjvm, MSN, RN]

The majority of the IW's don't like you to meet them at hme, unless they cannot drive for specific circumstances. I have only visited one home so far, everyone else requested to be seen at Dunkin Donuts, Dr's offices or any other public place, and it is encouraged ( I have been trained to try to meet IW's in public places). Most of the visits are completed at the physician's offices while waiting to be seen by the doctors. I like it but every week find a new thing to learn, a new way to treat a file. The advocacy is not really noticed by everyone involved, the IW's that really want to recover and go back to work they appreciate all the efforts you make to coordinate their needs as fast as possible, to obtain authorizations right away even though sometimes you have to go the extra mile to help them, but the ones outthere trying to live out the system, those don't appreciate what we do and think we are paid by the insurance companies and we will not represent them.Here, where I work there is not much, much that can be done since the worker's comp function as a managed care company that means that " saving" is priority of course if there is medical necessity we will go for what the IW needs, again,Ilikeit better now even thoughI still struggle and I'm in the learning process, the driving OMG! that kills me, I still have to learn to accommodate the appointments to my convenience that does not work the majority of the time for many reasons. I guess and hope it will get better soon. Thank you All for the inputs.

[WC Case manager]

I have learned throughout the years of doing this that I have one motto. "I do what is right". We can be put between the IW and the insurer. And I have learned to do the right thing. It always works. Yes there are those that do not want to return to work. And we do what we can to assist in their recovery. And at times the insurer wants to find any reason to deny treatment. But if you know what is right and strive to do that, you will sleep well at night.

[nurseprnRN, BSN, RN]

Driving can be made quite tolerable and even enjoyable by the addition of NPR and Books on Tape (disk). I really learned a lot about interviewing listening to Teri Gross on Fresh Air (from KHYY in Philadelphia on NPR) and I actually miss keeping up with books now that I'm mostly in my office. And of course, the driving reimbursement (IRS rate is $0.55 per mile now, I think) paid my car payment, so my car was pretty much free. Gotta love that.

[Jon Holderfield]

Ah you have been seduced by the power of the dark side and have now joined the Sith. In my humble opinion those nurses who decide to work as nurse case managers on behalf of insurance companies should no longer be allowed to use nurse as a title or refer to themselves as nurses because at that point they are no longer Advocates to the patient at all they are Advocates of the insurance company's bottom line and conserving money. I have witnessed many horrific behind the scenes actions taken by nurse case managers in order to get treatments cut off payments ended and workers shoved back into jobs that they're clearly not healthy enough to return to all in the name of the case manager doing their job. If they say they advocate for the patient then their line simple as that because in their line of work you cannot possibly advocate for the patient and have your job description literally entail doing everything you can to cut benefits and get Workers back on the job as soon as you can make it happen regardless of whether or not they're ready okay whether it's talking to and coercing The Physician into signing him back into full Duty release or, even worse essentially calling the Injured Workers liars and exaggerators and anything else that need to be said to negatively put the injured worker in a bad light in such way that the doctor can feel compelled to follow the insurance companies recommendation. I have the unique perspective of being a registered nurse and of having been a severely injured worker who had to be on the other side of the workers comp system who had a nurse case manager assigned to me and her entire MO was sneaking around behind my lawyer in my back coercing and pushing the position to achieve the ends laid out by her employers while at the same time smiling and pretending that she actually gave 2.5 craps about the General Health and well-being of the injured worker. As far as I'm concerned a nurse who no longer advocates for patients and works for an insurance company is no different than a doctor who has decided to transfer his skills over into say illegal organ trading or opening up a pill Mill just for money

[Jon Holderfield]

The minute that your paycheck is now officially paid by an insurance company and that is where your loyalties and obligations to succeed lie with, then you are a nurse no longer. And any other setting it's the patient's dues to pay your bills and therefore you are trained and schooled and expected to be their advocate. As a workers comp nurse manager, these Injured Workers aren't paying you you were being paid by the insurance company to do everything you can to find ways to get their benefits cut off get them back to work and do whatever you need to do or say whatever you need to do to make that happen and it says it is there's a lot of good nurses out there but every once in awhile there's a few bad apples that fall through the crack and those are the ones that end up working for these types of insurance companies, and sometimes the tactics that I've witnessed them doing so underhanded it's stunning and gives all nurses through Pride themselves on ethical behavior and true caring about how come a patients. The breakdown is very simple, either you work in a real setting as a nurse where you apply for holistic in general care of the patient against all those who would harm or neglect or mistreat or you work for an insurance company to preserve their bottom line which initially involves you working against the patience and doing everything you can to make sure that they do not get to keep benefits and I do not get to keep receiving disability checks because that is exactly what your employer is paying you to do that would be like saying that you're a vegan animal lover and work for the ASPCA but then get a job by Tyson meat packing plant hacking up farm-raised chickens

[Marisela Walsh]

I know this is an old thread but thank you for it. I have been a wccm for a little over a year and was feeling the same as you...what's the purpose of my role?! This explanation is wonderful. Thanks again.