Happy Thursday team!
By special request, this week’s tip outlines what to know about medical management services (aka nurse case managers) in Georgia.
JOHN’S GEORGIA TIP OF THE WEEK: Nurse Case Managers – What to Know
In claims involving non-catastrophic injuries, Employer/Insurers may voluntarily utilize qualified medical case managers (AKA nurse case managers) to provide telephonic or field medical case management services. Such medical management services may be provided at the expense of the Employer/Insurer. Board Rule 200.2
WHAT TO KNOW
- Certifications or Licenses/ Registration: Qualified medical case managers MUST:
- possess AT LEAST ONE of the following certifications or licenses: Certified Rehab Counselor (CRC), Certified Disability Management Specialist (CDMS), Certified Rehab Registered Nurse (CRRN), Work Adjustment and Vocational Evaluation Specialist (WAVES), Licensed Professional Counselor (LPC), Certified Case Manager (CCM), Certified Occupational Health Nurse (COHN), OR Certified Occupational Health Nurse Specialist (COHN-S); ***AND***
- REGISTER with the Board as provided in the Board’s Rehabilitation and Managed Care Procedure Manual.
- Consent of Employees/ Duties
- Consent of the employee (or their attorney) is REQUIRED for any qualified medical case manager to work with the injured worker.
- When ATTENDING any medical appointment, the consent must be in WRITING.
- Where consent is required, it may be WITHDRAWN and the Employee shall be informed in writing that such consent may be refused.
- Medical Case Managers Do NOT Need the Claimant’s Consent to:
- contact the ATP “for purposes of assessing, planning, implementing, and evaluating the options and services required to effect a cure or provide relief;” OR
- Assist with approval of WC-240 Job Descriptions
- *** NOTE: Prior to initially contacting the ATP, the medical case manager working WITHOUT the Claimant’s consent must give all parties & attorneys of record WRITTEN notification of being retained by the Employer/Insurer.
- Communication (All communications are subject to Provisions of Board Rule 200.1(II)(D))
- Medical case managers are required to provide copies of ALL medical records, medical reports, office notes, test results, and all other written documents received from the ATP to ALL parties and their attorneys.
- Board Rule 200.2 DOES NOT APPLY to:
- “a direct employee of the insurer, third party administrator, or employer, or to an attorney representing a party provided their specific role is identified.”
I hope everyone has a great rest of their week! As always, feel free to give me a shout if you run into any GA issues or have any questions.
Sincerely,
John Fennelly | Junior Partner