Health Services Coordinator (HSC) Qualifications & Requirements

1. Bachelor's or equivalent degree AND three (3) years experience in direct patient care, return-to-work coordination, occupational health care, or equivalent experience OR seven (7) years experience in direct patient care, return-to-work coordination, occupational health care, or equivalent experience.
   • Direct patient care includes nurse, medical assistant, nurse navigators, and care coordinators, but does not include referral coordinators, schedulers, or clinical administrative staff.
2. Able to obtain and maintain an L&I Provider ID, and bill HSC services.  No reported issues with Labor & Industries.
3. 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.
4. Must successfully complete L&I required training and/or testing.

Assistant Health Services Coordinator Minimum Qualifications

1. Three (3) years experience in direct patient care, return-to-work coordination, occupational health care, or equivalent experience.
   • Direct patient care includes nurse, medical assistant, nurse navigators, and care coordinators, but does not include referral coordinators, schedulers, or clinical administrative staff.
2. Able to obtain and maintain an L&I Provider ID, and bill HSC services.  No reported issues with Labor & Industries.
3. 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
4. Must successfully complete L&I required training and/or testing.

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 and PRP annually, and no more than 600 claims per surgical HSC annually. 

Examples of standard work include:

1. 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.
2. 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).
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.

In addition, HSCs support providers' best practice work and training.  Visit the information on each program's website for more information:

• COHE HSCs
• Surgical HSCs
• PRP HSCs 

L&I is currently developing HSC training materials.  More materials should be available through the first quarter of 2023.

Training 1: Introduction to Washington Workers' Compensation

Training 2: Introduction to the Claims Process

Training 3: FileFast (Direct Entry Report of Accident)

Training 4: What is an HSC?

Training 5: What is a Surgical HSC (SHSC)?

Please refer to your best practice program's Special Fee Schedule for more information:

• COHE 
• Surgical
• PRP