RH1002: INTRODUCTION TO WORKER'S COMP CASE MANAGEMENT
by Lynne Holman, RN, BSN, CCM

TAKE COURSE

OBJECTIVES

The learner will be able to:

 1. Identify the necessary "tools" used in  case management.

 2.  Explain how  to set up a case management file.

 3. Describe how a case management referral is made.

 4. Identify which kinds of cases are appropriate for case management.

 5. Prepare an appropriate " Action Plan".

 6. Write three required monthly reports.                 

 7. Relate how to obtain a " Release of Information".

 8. Describe how to do the "three point contact".

 9. Define insurance terminology that is used in case management.

10. Describe the case managers role in the return—to-work effort.

OUTLINE

A. Introduction
B. Workers’ Comp Tools
C. Treatment Guidelines
D. Relative Value Study
E. Definition of WC Case Management
F. Cost Containment
G. Understand Your Limitations
H. Determining Causality
I.  Reasons for Case Management
J. Case Management Activities
K. Release of Information
L. Assessment
M. Monitoring Compliance
N. Return-to-Work Release
O. Cost Control or Cost Management
P. Patient Advocate
Q. Catastrophic Case Management
R. Action Plans
S. Independent Medical Evaluation (IME)
T. Claimant’s Job Description & Physical Requirement Report
U. Case Assignments for Medical Management
V. Setting up a Case Management File
W. Case Management Reports
     1. Initial File Review
     2. Progress Report
     3. Closure Report

X. State Specific Workers Comp Laws