Field Nurse Handbook

Part 4

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1. Overview. In certain cases requiring Disability Management intervention, it is beneficial for the Claims Examiner (CE) to assign a Field Nurse (FN) to assist in the resolution of a specific issue or "task" hindering the progress of a case. This "task-based" FN assignment usually occurs in the later phases of the Disability Management process, and most often after the Early Disability Management FN assignment period has ended.

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2. Reasons for Task-Based Nurse Assignments. Task-based FN assignments are narrowly focused and more limited in their scope of nurse case management services. Task-based assignments do not require the same level of intervention or intensity as is seen with the Early Disability Management FN assignments, and will reflect a more limited timeframe and expenditure allowance.

Task-based assignments may include, but are not limited to:

a. Facilitating/coordinating a referral to one or more medical specialists and/or assisting the injured worker (IW) in identifying an appropriate treating physician.

b. Reviewing medical records from the case file, as made available to the FN by the CE, to ensure that appropriate medical treatment plans and recommendations are in place which are consistent with facilitating medical recovery from the work-related injury and progressing the IW toward re-employment. Such a review may also be performed for long term disability cases to assess the IW's status and progress, as well as evaluating cases in need of nursing home placement or other assisted living situations, etc.

c. Taking a second opinion medical report or Functional Capacity Evaluation to the treating physician(s) for review and comment in an attempt to obtain stable and well-defined work restrictions. This may be helpful in cases where the claimant has multiple and/or complex medical conditions, and therefore perhaps multiple treating physicians, requiring medical coordination prior to a release to work.

d. Arranging an on-site visit/appointment at a medical provider's office to obtain medical treatment records that have been difficult to obtain and are necessary for case progression.

e. Assessing the IW's needs for home and/or vehicle modifications, in conjunction with an OWCP vocational rehabilitation counselor.

Task-based assignments should not include: Assignment for provider enrollment or outreach and/or obtaining or providing authorizations on cases that otherwise do not meet the criteria for nurse case management assignment(s).

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3. Assigning a Field Nurse. As with Early Disability Management FN assignments, the process begins with the CE sending a referral to the Staff Nurse (SN), who prepares an assignment packet and issues the assignment authorization notification(s). In doing so, the SN assesses the special needs of the IW and refers the case to a nurse that has the skills to manage the case effectively.

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4. Interventions and Contacts. In general, the expectations for the FN interventions remain the same as those set forth for Early Disability Management FN assignments. (See Part 3, paragraph 3 of this handbook).

FN contacts, however, will be limited to only those parties directly associated with the specified task, which may include both face–to face meetings and telephonic intervention activities. The FN should structure his/her interventions and contacts in such a way as to resolve the specified task goal(s) and objective(s) within the authorized timeframe and expenditure limits.

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5. Timeframes. Timeframes for completing a task-based FN assignment are dependent upon the specified goal(s)/objective(s) of the assignment. However, task-based assignments are generally limited to no more than 60 days. Consideration may be given for extending the task-based assignment; however, an extension on a task-based assignment should not extend services beyond 60 days (120 days total).

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