What is the meaning of a case manager and what is their job?

this is for workmens comp

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  • 1 decade ago
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    Definition Workers' Compensation Rule 2.1295 states, "Medical Case Management refers to the planning and coordination of health care services appropriate to achieve the goal of medical rehabilitation. Medical case management may include, but is not limited to, care assessment, including personal interview with the injured employee, and assistance in developing, implementing and coordinating a medical care plan with health care providers, as well as the employee and his/her family and evaluation of treatment results. Medical case management is not the provision of medical care. The goal of medical case management should be to avail the disabled individual of all available treatment options to ensure that the client can make an informed choice."

    Role of the Medical Case Manager The MCM's role may be better understood by recognizing how it arose and how medical management fits into the workers compensation system. An injured worker is entitled to medical care and treatment that is reasonable, necessary and related to their work injury. The employer (or carrier) is required to provide the worker these medical benefits. However, the injured worker has a right to choose their physician and health care providers. The employer/carrier must bear the cost of medical care the worker selects, but the carrier may take action to ensure the efficient delivery and proper utilization of such medical benefits. The MCM is hired by the employer/carrier to medically follow or medically manage the injured worker.

    Qualifications Most medical case managers are registered nurses (RN?s). The Vermont workers' compensation system requests that MCM's obtain licensure by the Vermont Board of Nursing. MCM's are also required to have relevant work experience working with claimants in the Vermont workers' compensation system. The Department requests that MCM's without this specific work experience commence work as Interns, working under the direct supervision of an experience MCM.

  • 1 decade ago

    you usually work for a company and your job is to reduce what the company pays for worker's comp. you stay on top of the worker's comp 'cases' - people who have filed for worker's comp - and hound them for required paperwork, doctor's reports etc, make sure the company meets their obligations in worker's comp etc. ideally you help people figure out how to get back into working. sometimes they need a different kind of job. you might negotiate that kind of stuff. you will learn a lot about worker's comp law and requirements. you will be torn between compassion for hurt people who got hurt on the job and the company's desire not to compensate them or keep them on the job. that part is tough. you have to balance both. sometimes the company is being overly harsh and sometimes the employee is trying to play the system (and could probably really work). it's an interesting job and you basically expedite the claims. maybe similar to an insurance claim expediter. because worker's comp is a type of insurance. the insurance company would prefer not to pay and the insured would prefer to get maximum compensation. same deal here.

  • 1 decade ago

    A case manager is someone who manages your case(claim) and their job is to find out the facts surrounding your situation for workman's compensation and either make a decision as to if you are eligible or not, or to pass their evaluation and recommendations off to a higher authority to either accept or reject the application.

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