Training Resources
Training Resources
The purpose of the Case Manager is:
1. To make sure all legitimate and valid OWCP injury claims get accepted by understanding denial letters and reading doctors’ narratives to make sure the detail is great enough to get claims approved.
2. To track and make sure all treatment ordered by the MD is completed unless the treatment team determines that the patient is not making progress or is ready to return to work full duty. The reason for this step is to help patients progress, get better, and return to work full duty. Patients who are not attending medically indicated treatments may not improve and be able to return to work full duty.
3. To help keep patients organized with all of their forms and DOL letters.
4. To help patients receive all of the financial benefits afforded to them by the OWCP system.
5. To take calls and answer questions from patients nationwide. This includes answering questions sent to us from our website and helping answer questions sent to us on social media platforms such as Facebook.
6. To coordinate appropriate referrals to DOL attorneys as needed as a last resort.
7. To review all documents provided by new patients and develop a plan of action for the doctor’s office to follow.
The Case Manager should not be concerned with billing or collections. The Case Manager’s job is not to maximize revenue. It is to keep patients and doctors organized and keep each individual case organized. It is to help patients with the confusing system of OWCP and as a result help the office better manage each OWCP injury claim.
The case manager should be fluent in the following forms:
CA1, CA2, CA2aCA16CA17CA7, CA7a, CA7b, SF-1199aCA20OWCP 915OWCP 957
The case manager should read and understand all letters to patients from DOL and highlight the portion of the letter that gives the decisions and rationale of decisions so to develop a plan of action for the patient
The most important time in the case of a DOL patient is the first visit. The first visit is when we do a thorough intake and make sure the patient is organized so the doctor can do a complete and detailed initial history and physical to get the patients OWCP injury claim accepted. This is critical. Denied cases cause patients to lose access to all of their work injury benefits and prevent them from getting all of the treatment needed to get back to work safely at full capacity.
The Case Manager will understand and use:
1. The Case Management Spreadsheet
2. The Case Management System document
3. This Case Management Job Description
The Case Manager should be able to work from a home office and coordinate with all Federal Injury Center offices. The following will be needed:
1. A quiet work space so that patients on the phone are not confused during phone calls.
2. Cell Phone
3. Computer
4. Video and Audio capability from the computer.
5. Access to the EMR in order to view and share documents.
1. Take calls and answer questions from patients.
2. Track all prescriptions for therapy to make sure patients are attending all ordered therapy sessions.
3. Read DOL Denial Letters to understand why claims were denied.
4. Read medical narratives to check that enough detail is present to allow claims to be approved.
5. Ensure that all new patients attend their initial visits with the doctor so that claims can be approved.
6. Review all documents provided by patients and develop a plan of action for the doctor’s office to follow.
7. Review narratives to ensure the plan set forth by you was included in the narrative to ensure acceptance.
Note: Certain responsibilities may not have been included above which may be considered usual and customary to the performance of this or any position requiring high attention to detail. It is also noted that in the case where duties were not included because at the time of writing this document there was no need, perceived need, or a simple or gross omission of a duty which should have been included, those duties may be added to this description at a later time. This description can be added to, amended and/or changed with proper notification. Notification can be verbal. Any change or addition to the above are to be instituted immediately and the performance of such shall not be discontinued without written notification.