Nurse Case Manager Job Duties

The number of people being hired in the Disability Service Improvement (DSI) experiment as nurse case managers just for Region I -- 90 -- plus the job title, which is the term used in workers compensation and long term disability cases for personnel who often have an adversarial relationship with claimants leads to some concern about what Social Security is up to with Nurse Case Managers. Social Security has published a job announcement for more personnel to be hired for this position. The announcement gives the following job description:

Provides expert medical policy, procedural, and technical advice and guidance to DDSs, ROs, ALJs, the DRB, OQP and the national network of experts affiliated with the OMVE on the most complex issues encountered in making the determination or decision in a disability claim. This technical advice and guidance includes confirming what medical, psychological and vocational expertise is needed as well as verifying the need for additional medical or lay evidence, tests, or a consultative examination. Verifies that the request is in accordance with disability law, regulations, and policy.

Serves as a medical program expert and technical authority by providing technical advice on medical disability program issues, concerns, initiatives and requirements. Provides oral and written reports and conducts briefings on behalf of the Director to other SSA central office and regional components.

Provides expert medical advice and guidance for cases with multiple impairments to the DDSs, ROs, ALJs, DRB, OQP and the national network of medical and vocational experts.

This job description does not suggest that the Nurse Case Managers will have any direct contact with claimants, but it does suggest that the Nurse Case Managers may play something of an advocate's role in the process. They could be present at ALJ hearings, by video, to explain why the prior decision denying the claim was right. Still, the job description raises as many questions as it answers.

There is a worrisome history behind the idea of "case management" in the Social Security disability programs. The first recommendation that Social Security ought to have case managers that I can find came from Patricia Owens, formerly head of the Office of Disability Operations at Social Security and more recently an advisor to UNUM, the nation's largest Long Term Disability (LTD) insurer. She was pushing "case management" in 1999 in testimony to the House Social Security Subcommittee and she clearly had in mind people who would find a way to get claimants back to work, or at least off Social Security disability benefits.

The General Accounting Office, now the Government Accountability Office (GAO), picked up on this. The GAO testified, approvingly, in 2000 to the House Social Security Subcommittee about the practices of private long term disability insurance companies who were using nurse claim managers, among other personnel, to "encourage" recipients of long term disability (LTD) benefits under employee pension plans or under private insurance plans to return to work. GAO rehashed much the same subject in an early 2001 report. In 2002, in a report on disability determination at both Social Security and VA, GAO again urged "case management." None of the GAO reports acknowledged that the return to work "encouragement" was often perceived by the LTD recipients as harrassment aimed at lowering resistance to termination of benefits or that, in general, the insurance companies' handling of LTD claims has been extremely controversial in recent years.