Why Does SSA Need to Hire 90 Nurse Case Managers For Disability Service Improvement?

The Government Accountability Office Report on the Disability Service Improvement (DSI) plan, delivered at last week's House Social Security Subcommittee hearing, contains the news that as part of DSI Social Security plans to hire 90 nurse case managers by the end of 2006. By contrast, Social Security plans to hire 103 Reviewing Officers by the end of 2006. The GAO report says the following about the nurse case managers:

In addition, SSA is creating a Medical and Vocational Expert System, staffed by a unit of nurse case managers who will oversee a national network of medical, psychological, and vocational experts, which are together responsible for assisting adjudicators in identifying and obtaining needed expertise.

Why does Social Security need almost as many nurse case managers as Reviewing Officers? The "national network" does not exist at this time as anything other than a hazy concept, at least insofar as the public has been informed. In Region I there may not be as many as 90 people total employed by state disability determination units as physicans and vocational experts. Why are 90 people needed to manage them?

Why would this "national network" need anyone with the title of "nurse case manager" anyway? Here is a definition of "case management" from the Commission for Case Management Certification (CCMC): which certifies nurses as case managers:

Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client's health and human service needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcome

The CCMC goes on to state:

Case management is an area of specialty practice within one's health and human services profession. Its underlying premise is that everyone benefits when clients reach their optimum level of wellness, self-management, and functional capability: the clients being served; their support systems; the health care delivery systems; and the various payer sources.

This does not sound like a job in which an individual merely makes sure that physicians and vocational experts are available for consultation with decisionmakers. It sounds a lot like someone who would work directly with a claimant to try to get him or her back to work. That is how nurse case managers have been used by insurance companies dealing with workers compensation and long term disability (LTD) cases. Nurse case managers in workers compensation and LTD cases often end up in an adversarial relationship with the people whose cases they are managing.

At a time when Social Security's resources are stretched to the point that the Commissioner of Social Security is threatening to furlough employees, the nurse case manager position must be an incredibly high priority to justify hiring 90 new employees. That justification is not immediately obvious. The temptation is to suspect that some controversial role for the nurse case managers is in the works.