This unit applies to job roles such as injury management advisers and case managers of claims and may be applied in the claims area of the personal injury management and rehabilitation sectors.

ELEMENT

PERFORMANCE CRITERIA

1. Manage case load

1.1. Understanding of the skills required to prioritise case load management is demonstrated

1.2. Strategies are implemented and used to manage case load commitments in line with current personal injury case plans, timeframes and in accordance with organisation guidelines

1.3. Strategies used for keeping stakeholders consulted and informed of the progress of each case are implemented

1.4. Strategies used to monitor and review progress of current case loads are implemented

1.5. Strategies and referral processes for managing and handling non-timetabled events and situations are implemented

1.6. Organisation strategies for meeting, reporting and data submission commitments for the case load are followed

1.7. Case management loads are maintained in accordance with organisation and legislative requirements

1.8. Where necessary, additional personal injury cases are referred to appropriate personnel

2. Ensure case management model is applied

2.1. Organisation procedures and guidelines are adhered to throughout the personal injury management process, from referral to closure

2.2. Appropriate internal or external stakeholder referrals for injured workers requiring personal injury management and vocational rehabilitation services are sought

2.3. Organisation guidelines and procedures are followed for the collection of information required, from initial assessment through to case closure

2.4. Personal injury plans and programs are implemented using a cooperative approach ensuring all stakeholders are informed of plan requirements

2.5. Appropriate agreement, signatures and authorisations are obtained prior to an injured person returning to work

2.6. Contact, monitoring, review and closure process are adhered to and used in accordance with organisation requirements

3. Conduct an initial assessment

3.1. Contact is made with stakeholders to gather relevant information on personal injury case in accordance with organisation guidelines and legislative requirements

3.2. Additional information is sought and obtained from relevant stakeholders as required

3.3. Initial interview and assessment is conducted in accordance with organisation guidelines and legislative requirements in order to determine conclusions

3.4. Need for specific assessment and referral services is determined in line with legislation, and referrals are provided for these in accordance with organisation policies and procedures

3.5. Appropriate information required to support the referral process (internal and external) is provided to stakeholders in accordance with organisation guidelines and legislative requirements

4. Plan case

4.1. Agreement on goals is made, in consultation with client, treating medical practitioner, employer and other key stakeholders

4.2. Additional sources of information relevant to the rehabilitation planning and process are identified and accessed appropriately

4.3. Appropriate goal setting process are negotiated with the person in accordance with organisation guidelines

4.4. People are assisted, in accordance with organisation policies and procedures, to demonstrate costs and benefits of options to assist them with the decision making process

4.5. Case plans are developed

4.6. Strategies for obtaining approvals from the treating medical practitioner and stakeholders prior to the commencement of a return to work and health program are obtained in accordance with organisation policies and procedures

4.7. Regular communication is maintained with relevant stakeholders throughout the rehabilitation program

5. Monitor and review case progress

5.1. Organisation guidelines are used to determine when to schedule multidisciplinary team and review meetings

5.2. Organisation processes are used to identify services, costs and methods of evaluation at each stage of the rehabilitation process

5.3. Indicators and triggers which suggest modification or alteration to the case plan are identified in accordance with organisation guidelines and case plan is modified or altered accordingly

5.4. Organisation guidelines are used for monitoring the progress and effectiveness of a person's case

5.5. Techniques are used in assisting an injured person with the long-term management of their injury

6. Ensue effective program closure

6.1. Organisation policies and procedures, and legislative requirements are used to identify when the provision of case services are no longer appropriate

6.2. Closure interviews or contact with the worker, are communicated using appropriate techniques

6.3. Consultation with relevant stakeholders required at the vocational program closure is undertaken in accordance with organisation guidelines and legislative requirements

6.4. Program closure is recorded and files are archived in accordance with record keeping requirements

Required skills

highly-developed communication skills to:

determine and confirm information, using questioning and active listening as required

develop a network of relevant stakeholders

provide effective consultation

liaise with others, share information, listen and understand

use language and concepts appropriate to cultural differences

numeracy and IT skills to:

perform calculations related to achieving required outcomes

use computer applications (word processing, spreadsheet, database, specific purpose computer systems) to assist in achieving required outcomes

access and update records electronically

use internet information

well-developed literacy skills to:

read and interpret documentation from a variety of sources and record and consolidate relevant related information

interpret and apply legislation, regulations and policies and procedures relating to maintaining effective personal injury case loads

research and analysis for accessing and interpreting relevant information

effective interpersonal skills

organisation skills, including the ability to plan and sequence work

teamwork skills for working with relevant stakeholders to achieve rehabilitation goals

Required knowledge

relevant organisation policies and procedures to assist in the management and compliance of personal injury claims

The Evidence Guide provides advice on assessment and must be read in conjunction with the performance criteria, required skills and knowledge, range statement and the Assessment Guidelines for the Training Package.

Overview of assessment

Critical aspects for assessment and evidence required to demonstrate competency in this unit

Evidence of the ability to:

manage case loads effectively and provide individual case management

conduct initial assessment service in the case management process to plan rehabilitation services with relevant stakeholders

monitor and review rehabilitation progress

provide effective closure interviews demonstrating knowledge of organisation policies and procedures on case management and relevant legislative requirements.

Context of and specific resources for assessment

Assessment must ensure:

competency is demonstrated in the context of the work environment and conditions specified in the range statement either in a relevant workplace or a closely simulated work environment

access to and the use of a range of common office equipment, technology, software and consumables

access to organisation records

access to organisation policies and procedures.

Method of assessment

A range of assessment methods should be used to assess practical skills and knowledge. The following examples, in combination, are appropriate for this unit:

evaluating an integrated activity, which combines the elements of competency for the unit, or a cluster of related units of competency

observing processes and procedures in workplaces

verbal or written questioning on underpinning knowledge and skills

evaluating samples of work

accessing and validating third party reports

setting and reviewing workplace projects and business simulations or scenarios.

Guidance information for assessment

The range statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Bold italicised wording, if used in the performance criteria, is detailed below. Essential operating conditions that may be present with training and assessment (depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts) may also be included.

Case load management may include:

allocating time for problem solving

clustering interviews

dealing with stakeholders

diarising contracted services and follow-up

monitoring case loads and progress

reviewing work plans on a weekly basis

rescheduling when necessary

scheduling time for mail, answering calls

scheduling time for new referrals and assessment interviews, work site visits, preparing referrals, report and data submission

using diary and planning grids.

Plan requirements may include:

equipment modification requirements

information on other stakeholders

medical requirements

resource and equipment requirements

timing requirements

venue requirements

workplace/home modification requirements.

Stakeholders may include:

allied health professionals

community organisations

co-workers

family members

insurers

reviewing and consulting medical practitioners

treating medical practitioners

unions and union representatives

work trial hosts

workplace supervisors.

Case plans must include:

appropriate services

appropriate timeframes

associated costs of achieving rehabilitation.

Multidisciplinary teams may consist of:

community groups

employers

medical rehabilitation specialists

social rehabilitation specialists

vocational rehabilitation specialists.

An injured worker's long-term management of their injury may include:

methods of maintaining physical fitness once the program is complete

self-monitoring activity in the workplace.

Closure interviews or contact with the worker may include:

goals achieved

self-management strategies

timelines for case program closure.

Consultation may include:

documented evidence of communication and agreement by other stakeholders

documented evidence of contact with injured work, indicating discussion and agreement for case closure.

Unit sector

Personal injury management

This unit contains employability skills.