Health Services Coordination

Success Stories

Health Services Coordination is case management that benefits workers. These professionals, embedded within healthcare organizations, offer a vital link between workers, employers, and providers. Below are real-world stories that illustrate their good work.

Health Services Coordinators' Collaboration Leads to Positive Results for Workers -November 2024

A worker was seen at the emergency department for multiple injuries when they fell at work. They had a wrist fracture and were then seen in Orthopedics. The wrist fracture was the only condition documented on the Report of Accident (ROA). The Surgical HSC reached out to an HSC in Occupational Medicine to coordinate concurrent care. The worker was seen two days later by an Occupational Medicine physician who documented the additional conditions. The worker underwent surgery on their wrist a week later and additional conditions were added to the claim quickly and early in the claim. Good communication between the Health Services Coordinators ensured that the worker could receive all the medical care they needed to recover.

A worker was seen at the emergency department for a radial fracture. They were referred to Orthopedics and Occupational Medicine. The worker contacted Occupational Medicine to schedule an appointment. The worker stated that when they contacted Orthopedics, they were told to go to Occupational Medicine first. The HSC reached out to the Surgical HSC confirmed that the worker was seen, casted, and that Orthopedics would assume role of attending provider. This quick coordination ensured that the worker was seen quickly and got the medical care they needed to heal.

Surgical HSC (SHSC) helps worker get timely treatment - September 2024

A worker recovering from surgery developed a serious complication. The Surgical Health Services Coordinator (SHSC) recognized the critical nature of the diagnosis and worked closely with L&I to remove barriers and help speed the approval process for a new medication. Because of the SHSC's intervention, the surgeon became aware of the barriers more quickly, which also helped to resolve the issues. We appreciate the SHSC's efforts to advocate for this worker and ensure he had timely access to the medicine he needed to support his treatment.

Surgical HSC (SHSC) helps uncover serious medical condition - July 2024

An injured worker in his twenties was not recovering with conservative care. The Surgical Health Services Coordinator (SHSC) administered the Pain and Function scale over the course of several weeks, which documented his worsening condition. The SHSC was in regular contact with the worker and alerted the surgeon to these findings. When the surgeon ordered additional diagnostic testing, a serious underlying cancer was discovered. We wish this worker a speedy recovery and thank the SHSC for their efforts to support this worker during the treatment of his workplace injury.

Qualifications & Requirements

Health Services Coordinator (HSC) Qualifications & Requirements

Bachelor's or equivalent degree AND three (3) years' experience in direct patient care, return-to-work coordination, workers' compensation claims management, occupational health care, or equivalent experience OR seven (7) years' experience in direct patient care, return-to-work coordination, workers' compensation claims management, occupational health care, or equivalent experience.
- Direct patient care experience must primarily include collaborating with attending providers to develop, implement, or maintain treatment plans. Direct patient care experience should include experience building and implementing plans to assist patients in:
  - Setting and monitoring goals
  - Monitoring ongoing recovery, and
  - Identifying and addressing barriers and mitigations.
- Examples may include: nurse, medical assistant, vocational rehabilitation counselors, or claim manager.
- Direct patient care does not include referral coordinators, schedulers, clinical administrative staff, or ancillary services (examples: diagnostic care).
Able to obtain and maintain an L&I Provider ID, and bill HSC services. No reported issues with Labor & Industries.
Experience or demonstrated skills in:
- Oral and written communication with health care professionals, patients, employers, and insurance staff and resources.
- Data management and tracking.
- Completing care coordination or similar documentation.
- Analyzing and communicating provider, care coordinator, and best practice reporting data.
Must successfully complete L&I required training and/or testing.

Assistant Health Services Coordinator Minimum Qualifications

The purpose of this role is as an entry point for skilled staff who may not have all the experience required of Health Services Coordinators. The goal of the HSCA role is to serve as a pipeline to the HSC role, allowing candidates the opportunity to gain the skills and experience necessary for the HSC role.

At least three (3) years’ experience in direct patient care, return-to-work coordination, workers’ compensation claims management, occupational health care, or equivalent experience.

- Direct patient care experience must primarily include collaborating with attending providers to develop, implement, or maintain treatment plans. Direct patient care experience should include experience building and implementing plans to assist patients in:
  - Setting and monitoring goals
  - Monitoring ongoing recovery, and
  - Identifying and addressing barriers and mitigations.
- Examples may include: nurse, medical assistant, vocational rehabilitation counselors, or claim manager.
- Direct patient care does not include referral coordinators, schedulers, clinical administrative staff, or ancillary services (examples: diagnostic care).

Able to obtain and maintain an L&I Provider ID, and bill HSC services. No reported issues with Labor & Industries.
Experience or demonstrated skills in:
- Oral and written communication with health care professionals, patients, employers, and insurance staff and resources.
- Data management and tracking.
- Completing care coordination or similar documentation.
- Analyzing and communicating provider, care coordinator, and best practice reporting data.
Must successfully complete L&I required training and/or testing.

Standard Work

Health Services Coordination Standard Work

Health Service Coordinators (HSCs) assist providers, workers, and employers in a variety of ways. L&I has developed a core set of standard work for HSCs. We recommend no more than 1,650 initiated claims per HSC for COHE annually, and no more than 600 claims per surgical HSC annually.

Examples of standard work include:

Coordination and tracking of referrals:
- Track referrals through provider chart notes and follow up with the worker to ensure that they have engaged with referred services.
- Contact referred providers' offices as needed.
- Check with workers to see if there are any barriers to completing referred services and work to resolve them.
- Review provider chart notes to determine next steps and assist when needed.
Assessment of barriers to recovery:
- Conduct Functional Recovery Questionnaire (FRQ) and report positive FRQs to attending providers.
- Document pain and function scales to ensure that progress is being made. Alert attending provider if pain and function scales show that progress is not being made.
- Complete other assessments as needed (ex: HSC's barriers assessment).
Ongoing monitoring of recovery:
- Review new workers, work lists, and tasks daily.
- Assist workers in navigating L&I and health care systems.
- Determine and follow up on HSC care coordination plan goals and next steps.
- Coordinate case conferences, refer to COHE advisors, and suggest PGAP or other programs as applicable.
- Assist providers and workers in completing occupational disease or opioid paperwork.
Refer to community services:
- Maintain a list of community resources and share them with workers as needed.
- Follow up with workers about community resources if it is part of their care coordination plan.
Assistance with medication issues:
- Explain the new prescribing best practices to providers (L&I resources and guidelines).
- Check with workers about their medication usage and if they're taking them as prescribed. Report issues to providers.
- Alert the attending provider if the patient complains of pain issues and/or shows drug-seeking behaviors. Discuss referrals to possible interventions (ex: PGAP) with provider.
- Remind providers about L&I opioid paperwork and requirements.
Coordination of return to work:
- Ensure that employer, provider, and worker understand restrictions, capacities, return to work expectations, programs, and assistance opportunities (ex: Stay at Work).
- Answer questions about L&I related programs.
- Assist employers with job descriptions; assist Vocational Rehabilitation Councilors (VRCs) working with providers to complete the job analysis review process.
- Communicate and coordinate with VRCs.
- Track work status and include return to work goals in the care coordination plan as needed.
Support during transitions of care:
- Assist workers in finding a new attending provider when needed.
- Assist providers in submitting transfers of care when needed.
- Assist workers coming from emergency departments and needing ongoing care to ensure continuity of care.
- Assist workers transitioning to and from attending provider care.
- Communicate with other health services coordinators when workers are transitioning to other providers.
Coordination of surgical care:
- Ensure communication to workers who are surgical candidates.
- Ensure that workers have pre-operative released to work plan.
- Ensure that workers have post-operative recovery and released to work plan.
- Communicate with surgeon when worker is not making progress on their post-operative recovery and released to work plan.
- Ensure that the worker transitions to a non-surgical provider when ongoing care is needed.