geminilua

Don't get discouraged. I too work as a nurse case manager for workers' compensation. When I first started, I had lots to learn. Fortunately for me, I worked for a great company with excellent training. It does take time to become a pro. I would say give yourself at least a year. And even when you think you know what you are doing, things change. Learn to go with the flow. I think what helps me the most is staying organized. Figure out a flow that works for you and your workday will go much easier. when you turn off your computer, don't think about work. This is particularly difficult, especially when you go on vacation and start thinking about all the emails, calls, diaries/tasks you will have once you return. Fortunately for me, I don't have to make treatment authorization decisions as all the treatment requests go to utilization review; however, when I worked for another company, I did have to do your, and sometimes it is tricky. Use your resources (ODG guidelines, dial-a doc, colleagues, manager, talk to the ordering provider) to make the best decision possible. Negotiate treatment- if you are not able to approve 20 PT visits, are you able to maybe approve 10? When you let the injured employee know that a treatment was not approved, let them know that it is based on guidelines and share the guideline with them. Also, the claims adjuster is really the person who makes decisions about what they will pay for or not whether it is within the guidelines or not. If you can, let them be the bearer of bad news! If you build a good rapport with the injured employee from day one, there is less of a chance of them yelling at you. Be nice, be kind, and be understanding of their situation. They may not like it when you give them bad news, but they will be nicer if they like you. You will have bad days and some people will yell and they will get an attorney, but don't take it personally. Do the best you can and remind yourself that you get paid well, you don't work holidays, you work M-F (probably 9-5) and you can't save the world -unless you have a magical power we don't know about :)