Pros and Cons of Using a Nurse Case Manager

HR Resource
May 23, 2012 — 5,444 views  
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If you are injured at work, there are a lot of decisions to make in a very short period of time. One choice is whether to use a case manager for the duration of medical treatment. There are pros and cons of using a nurse case manager, and these are largely made up of the quality of the individual's work and what personal purpose they assign to the position.


Pros of using a nurse case manager

A nurse case manager can act as a benevolent guiding force if you are unsure of what is covered by your medical insurance. Their assistance can help contain the cost by reducing unnecessary expenses. Medical coverage lingo can often be tricky to decipher, and a misunderstanding can lead to expensive procedures done and material or treatments used when there are other, more affordable options.


One example in which the services of a case manager would be useful is allowing you to choose between the name-brand drug and a general-label prescription. Saving just $1 on each pill can really add up in the long run when combined with other medical costs.


Cons of using a nurse case manager

Some states require a nurse case manager employed by the Medical Case Management Provider to work very closely alongside the injured party. They will schedule and authorize all doctor appointments and while some patients appreciate this level of committed assistance, others may find such a constant presence intrusive. You may even begin to feel as if the nurse case manager is steering the course of treatment too much and overshadowing your treatment desires.


In addition to the high level of attention, you may find a case manager working for the benefits of the insurance company or hospital and not acting in your best interest.

"For managed care companies to turn that [the concept of a case manager as patient advocate] around to make this basically a gatekeeper to services is an abomination," Jamie Court, director of Consumers for Quality Care, a healthcare watchdog group based in Santa Monica, California, told NurseWeek. "A case manager who is simply trying to cut costs is not a patient advocate, and case managers should always be patient advocates."

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