What is medical case management?

Medical case management involves the utilization of a Registered Nurse (RN), also known as a Nurse Case Manager (NCM), in the course of a medical claim. Most NCMs are also certified (such as with a CCM credential, which stands for Certified Case Manager). The NCM acts to facilitate communication among the involved parties of the claim (i.e., patient, provider and adjuster and sometimes the employer). They also coordinate complex aspects of medical care in order to achieve greater efficiency. The NCM prevents delays in treatment and also avoids miscommunication, which can often occur when an NCM is not used. NCMs also track a patient’s progress with regard to disease management. NCMs identify the most appropriate providers and resources, and they identify the most efficient pathways to recovery. With complex and catastrophic cases, in particular, NCMs coordinate complex medical care often too difficult for adjusters to manage on their own. In workers compensation claims, NCMs shorten the recovery process, allowing for a faster return to work and saving indemnity costs (benefits paid to an injured worker based on their loss work time). In the workers compensation sector, NCMs also assist with expediting the rate at which Maximum Medical Improvement (MMI) is attained, which is a major benchmark on the claim.