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Nurse Case Managers
The Nurse Case Manager is valuable resource to help you ensure that your patient gets the health services and benefits they need to make the best recovery possible.
In cases where a worker has injuries or personal circumstances that complicate the recovery process, the Nurse Case Manager will act as their advocate and advisor, assisting their progress through a sometimes complex health care and benefits system. In these cases, the Nurse Case Manager will be your patient's main contact with WSIB.
Nurse Case Managers do not make diagnoses or treatment decisions, nor do they make judgements about your patient's eligibility for benefits.
Their role is to coordinate and facilitate access to timely and appropriate health care services, and ensure continuity throughout the recovery process.
This section will explain what Nurse Case Managers do and how they can help you, the health professional, achieve the best outcomes for your patient.
How will the Nurse Case Manager help my patient?
While the role of health professionals is to diagnose and prescribe treatment, the primary role of the Nurse Case Manager is to coordinate and facilitate care.
Work injuries can require diverse health services, and the health care and benefits system can be complex. So patients often find it challenging to understand and access the care and benefits they need. The Nurse Case Manager (NCM) can help your patient by acting as an advisor, an advocate, and a mentor throughout recovery and return to work.
The Nurse Case Manager will:
- Help your patient understand the goals and expected outcomes of treatments, services, and benefits;
- Identify their overall needs for recovery by assessing their injury, history, treatment plan, and progress to date. This will involve gathering information and recommendations from you and other health professionals providing care.
- Ensure continuity of care by acting as a liaison between various health professionals and services and by following the patient's case from point of injury to return to work.
- Act as a patient advocate by helping adjudicators and other parties understand the patient’s health care situation and health care needs.
- Coordinate care and services so that your patient can access them easily and quickly.
- Evaluate and monitor your patient's progress to recovery and return to work. In partnership with you and your patient, the NCM will develop a return to work plan with timelines based on the diagnosis and treatment you prescribe.
- Attempt to prevent recurrence by working with the employer and worker to create a safe work environment.
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How will the nurse case manager work in partnership with me?
In cases where the patient's circumstances or the complexity of their care plan require it, the NCM will contact you as soon as possible to open communications.
They will inform you of their role and involvement, and their availability to help. They will also help clarify our expectations of injured workers who are receiving benefits. Your diagnosis and treatment plan will form an important part of the NCM's preliminary assessment and case review. While you prescribe and monitor your patient ’s care, the Nurse Case Manager will act as a liaison between you, other health professionals, and various services, including our staff. When necessary, the NCM will also facilitate delivery of needed resources.
The Nurse Case Manager will interact with you in a number of ways that benefit your patient:
- Patient Assessment: As part of their comprehensive assessment, the NCM will collect your input on your patient's needs for recovery and challenges to return to work.
- Treatment Planning and Implementation: Based on your diagnosis and recommendations, the NCM will develop a case management and return-to-work plan with treatment details and timelines. The NCM will consult with you as needed to clarify treatment and coordinate services to help your patient achieve their recovery goals.
- Act as a liaison: The NCM follows your patient's case from point of injury to return to work, and can be an important communications link among you, other health services, employers, and WSIB.
- Provide information: The NCM may provide background information about your patient's case that will help you in your patient's care. The NCM is also familiar with WSIB processes and can answer questions you may have about work safety insurance.
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Which patients can benefit from case management?
In general, any patient who faces challenges regarding care and recovery is candidate for case management. This includes (but is not limited to) patients who are hospitalized, those who require care from multiple health professionals or services, and patients who have personal or psychological circumstances that may interfere with recovery.
Ideally, such cases are identified early by our Central Claims office based on the original documentation of the injury. Sometimes, however, these factors only become evident later in the recovery process.
Some factors indicating a need for a Nurse Case Manager include:
Complex or multiple injuries, or the patient is hospitalized.
- Treatment plan is unclear or requires coordination
- Patient's injury may permanently prevent return to the pre-injury work
- The patient has pre-existing medical conditions that may complicate or prolong recovery
- Patient needs assistance in accessing health care resources
- Emotional or psychological stress may interfere with recovery
- Concerns about the patient's home situation, perception of their injury, or their motivation to return to work.
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Can I request the assignment of a Nurse Case Manager?
Normally, when a Nurse Case Manager is needed, we will assign one very early after the original injury, so referral will not be an issue for you.
There are cases in which you may have pertinent information not available us. If you have information that may help us in deciding the need for Nurse Case Manager, you should contact your patient ’s adjudicator. In cooperation with a nurse case manager and, where necessary, a WSIB medical consultant, the adjudicator will review the case. If you do not know how to contact a patient's NCM, or whether they have an NCM at all, just contact the patient’s adjudicator. |
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