ATTORNEYS: DEFENSE OR PLAINTIFF.
Cases commonly worked on include:
1. Professional negligence.
2. Personal injury.
3. Products liability.
4. Toxic torts.
5. Workers compensation.
6. Medical case management.
7. Criminal.
8. Forensic nursing.
9. Expert witness.
10. Life care planning.
LAW FIRMS:
CLNC®’s are hired by Law Firms to provide assistance to Attorneys in cases involving healthcare and other medical related issues.
Activities often include:
1. Screening medical malpractice cases as they come in for merit.
2. Summarizing and analyzing medical records.
3. Conducting medical literature searches.
4. Locating and communicating with expert/testifying witnesses.
5. Developing demonstrative evidence, preparing affidavits, complaints, deposition and interrogatory questions/answers.
INSURANCE COMPANIES:
CLNC®’s are hired in the insurance industry to ensure that the health care services payable are according to the benefits of the insurance policy, provided in the most cost effective/efficient way possible and justifiable within that policy.
Accident, life and health insurance companies employ CLNC®’s to serve as:
1. Case Managers.
2. Utilization Review Specialists.
3. Medical Bill Auditors.
4. Policy Development Coordinators.
5. Claims Adjusters.
HEALTHCARE SYSTEMS:
Large healthcare organizations may have their own in-house claims or legal department, which function very similarly to an Insurance Company. CLNC®’s may preform roles very similar to those in an insurance company. (See above)
Hospitals, Ambulatory Care Centers and Clinics:
CLNC®’s are usually employed in the Risk management, Quality improvement or Corporate compliance department. They are usually the primary investigators of potential or filed claims involving patients who were injured during the course of medical treatment.
Their roles may include:
1. Review medical records.
2. Conduct patient/employee interviews.
3. Prepare reports pertaining to adverse patient outcomes
4. Participate in facility liability exposure meetings.
5. Provide in-service education for staff.
6. Make recommendations regarding resolution of claim.
7. Be a part of the litigation team.
8. Prepare employees for trial.
9. Recommend experts.
10. Obtain medical evidence.
11. Work with outside counsel.
12. Ensuring facility compliance with State and Federal regulations/standards.
13. Information management.
14. Healthcare privacy issues.
15. Identification/prevention of criminal/unethical activity within organization.
GOVERNMENT AGENCIES:
CLNC®’s may work in a variety of government Agency’s including:
1. Attorney General’s office.
2. Department of Justice.
3. State health Department.
4. State health professionals licensing boards.
5. Food and Drug Administration.
6. Department of corrections.
In this Role CLNC®’s may:
1. Assist in defense of state Agencies (e.g.) a. Medical schools.
b. College infirmaries
c. Prison Healthcare system
2. Write healthcare policies.
3. Write administrative rules based on statutes.
4. Work as administrators.
5. Be involved in compensation programs for injured citizens.
6. Assist in analysis/investigation of cases involving compensation for injury.
7. Investigate for government funded health care fraud cases.
FEDERAL OR STATE PATIENT SAFETY ORGANIZATIONS:
CLNC®’s role within the patient safety organization is to:
1. Analyze patient safety reports.
2. Aggregate data to identify trends in patient safety events.
3. Develop educational material to decrease recurrence of events that result in patient harm.
CLNC®’s are uniquely qualified for this type of work due to;
1. Their clinical training.
2. Risk management and quality improvement principles.
3. Knowledge of patient safety regulatory requirements, at both State and Federal levels.
PRIVATE CORPORATIONS, BUSINESS AND INDUSTRY:
CLNC®’s work with Attorneys and corporate health care associates on:
1. Workers compensation treatment.
2. Cost
3. Litigation issues.
4. Quality.
5. Risk identification and management.
6. Develop policies/programs for employee health issues, toxic exposure and loss prevention.
7. Auditing.
8. Product liability cases.
9. Medical policy coordination.
10. Provide information to support insurance coverage decisions.
In all cases CLNC®’s may work independently or be hired as an employee of the company.
