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NURSE CASE MANAGER

Case Management/Discharge Planning | Washington, DC | Full Time

Job Description

NURSE CASE MANAGER

Maintains each case in the OI-M tracking system’s case management and enters data, such as; management notes, appointments, restrictions, accommodations, disability, etc. Provides periodic reports regarding status of cases.

Monitors employee’s medical progress and duty status from the time of injury to return to full duty by conducting pre and post interviews with the injured employee and counsels the injured employee regarding their responsibilities. Obtains medical authorization release form from the employee? Provides CA—l7's to employee prior to each appointment with the primary treating physician and requests periodic medical reports at reasonable intervals from the employee which addresses his/hers ability to return to Work.

Ensure medicals and CA-l7’s are received timely and are complete. If medical documentation is not complete, returns documents to the employee with physician and employee instructional letters and requests employee contact their physician for the required information.

Contacts the physician in writing to obtain medical reports, obtain treatment plans, return to work dates, descriptions of work limitations, and informs the physician of light/limited duty positions available and the specific requirements of the position for possible assignment.

Upon return to work in a light/limited duty capacity, works with the employee and supervisor to ensure the duties to be performed are within the employee’s medical- restrictions and that both the employee and supervisor understands the limitations. 

Works with supervisor and BEP Workers’ Compensation Specialist to provide clarification of medical restrictions/limitations and/or provide advice regarding medications.

Contacts-OWCP claims examiners to obtain updated medical reports and assesses potential return to date of injury position or light/limited duty. Facilitates approvals for surgery or other medical procedures/services. Monitors treatment provided and notifies OWCP if it appears the physician’s care is inadequate, unreasonable or too lengthy and advises when a second opinion is needed.

Assists in expediting medical and vocation rehabilitation by maintaining periodic contact with OWCP field nurses and rehabilitation counselors regarding treatment progress diagnosis, expected recovery.

Gathers information and documentation to make recommendations to OWCP to close Workers Comp. cases.

Compiles documentation for pf all current applicable medical documentation for complex or unreasonable cases. This documentation may include medical records documenting periods of lengthy physician care, medical documentation of restrictions (or lack thereof) or inability to return to Work. This documentation will be provided to the Medical

Review Officer (MRO) for a medical advisory opinion regarding the need for additional evaluation, such as, a Functional Capacity Evaluation, or a determination of adequacy of documentation to support Work status/capability testing, Fitness for Duty test. The MRO may also address appropriateness of the treating physicians care, diagnosis or treatment, and the reasonableness of accommodation, restricted duty, no work etc. 

Review and identify cases on the charge back tiles provided by OWCP that need action by the Workers Comp. staff.

Participate in routine staff meetings and monthly management meetings in conjunction with other Workers’ Compensation committee members to provide an update of cases in progress.

Performs other related duties as required.

Performance of the Nurse Case Manager will be measured using the following reports and records:

1.  Develop and maintain SOP for organization of Worker’s Compensation files. 

2.  Provide a weekly report of active Worker’s Compensation cases to the WC Manager. 

3.  Each month prepare report of WCF-WC data for submissionl to DC-. This report must be submitted to Robert Naranjo of the Safety Division at BEP-D within 5 working days. This data is received from the OHM system and reviewed with the Workers Comp. Specialists for completeness. Update the Plant Managers summary file of LWD, COP days.

4.  Each month provide WC Manager with a summary list of all active cases with a summary of any action taken. Report Statistics on CA 1/CA2 turnaround time and length of time required to receive O-WCP case numbers.