The Case Manager
Healthcare in general is undergoing a profound transformation—in this article, I wanted to look at an area many of us don’t think about because we live in an urban or suburban area. Rural areas across the country are set to be hit the hardest as the Big Beautiful Bill is implemented after the November 2026 midterms.
If you read healthcare publications or listen to organizations like the Kaiser Family Foundation, the expectations across the country, but especially in rural areas, will be marked by shrinking access, hospital closures, and widening gaps in specialty care. Here are some sobering statistics from the American Association of Insurance Management Consultants. They report that nearly:
- 200 rural hospitals have closed in the past two decades, and 700 more are at risk, with 300 facing an imminent threat.
- These closures eliminate emergency care, inpatient services, and diagnostic services essential for timely workers’ comp treatment
- 78% fewer primary care physicians and seven times fewer specialists than in urban areas.
- Specialty care is especially scarce, even though one-third of injured workers require specialty services.
So, how are workers’ compensation nurse case managers working in rural areas preparing for the impact? Here are some tips that might help you and your colleagues gear up.
Map the New Care Landscape Before You Need It
Cuts and closures mean the old referral pathways won’t hold. Case managers can stay ahead by:
- Build or update your directories of remaining providers, urgent care centers, imaging sites, and specialists within a realistic radius.
- Identifying cross-border options (neighboring countries or states often have better access).
- Tracking which facilities offer telehealth, same-day appointments, or mobile services, and confirming which counties your populations live in to see if the services extend to them.
- Connecting with hospital discharge planners in advance to understand what services are disappearing and what alternatives they recommend.
This preparation prevents scrambling when an injured worker suddenly needs diagnostics or specialty care.
Leverage Telehealth as a Core Strategy, not a Backup
In rural workers’ comp, telehealth isn’t optional anymore—it’s a lifeline. Telehealth can dramatically reduce delays that would otherwise extend the duration of disability.
Case managers can:
- Pre-vet telehealth providers for orthopedics, pain management, behavioral health, and occupational medicine.
- Ensure injured workers have the technology, connectivity, and knowledge to use virtual visits.
- Advocate with adjusters for telehealth authorization early in the claim.
- Use telehealth for follow-ups, medication checks, psychosocial support, and employer meetings.
Plan for Transportation Barriers Before They Derail Care
With hospitals and specialists farther away, transportation becomes a clinical issue.
Case managers should:
- Identify transportation vendors that serve rural zip codes.
- Arrange mileage reimbursement or ride services early in the claim.
- Build contingency plans for weather, distance, and caregiver availability.
- Consider temporary lodging when multiple appointments are clustered.
- Proactive planning keeps care on track and reduces no-shows.
Strengthen Relationships With the Providers Who Remain
Case managers can:
- In rural areas, relationships matter more than networks. Go to conferences and meet people who work for companies that serve, or could serve, rural areas where there is a need for their services.
- Build rapport with local primary care providers, who often become the de facto quarterback when specialists are scarce.
- Communicate consistently with small clinics that may not have robust care coordination systems.
- Offer clear, concise updates so providers feel supported rather than burdened.
- When resources shrink, collaboration becomes the most powerful tool we have.
Address Psychosocial Risks Early and Often
Rural injured workers face unique stressors. You might consider checking in with the injured worker more frequently to see how they are doing and address any issues early.
- Isolation
- Financial strain
- Limited behavioral health access
- Transportation challenges
- Fear of job loss in small communities
Case managers can mitigate these risks by:
- Screening early for depression, anxiety, and fear-avoidance behaviors.
- Connecting workers to tele-behavioral health or community resources.
- Coaching employers on modified duty options that fit rural realities.
Psychosocial support is often the difference between recovery and prolonged disability.
Advocate for Early Diagnostics and Specialty Inpu
Case managers should:
- When specialty access is limited, delays compound quickly so it is important to have plan B and C ready to implement.
- Push for early imaging when clinically appropriate.
- Request peer-to-peer reviews or tele-specialist consults to avoid unnecessary delays.
- Document the impact of limited access to support authorization requests.
Use Creative Return-to-Work Strategies
Rural employers often have fewer modified duty options. Case managers can help by:
- Collaborating with employers to design safe, temporary tasks.
- Exploring remote or administrative duties when feasible.
- Partnering with vocational specialists early when return-to-work barriers appear.
A little creativity can help keep an injured worker connected to the workforce and reduce the duration of disability.
Stay Informed and Share Knowledge With Your Team
As rural healthcare shifts, staying current is essential.
- Follow KFF, NRHA, CMS, and state rural health offices.
- Debrief with colleagues about emerging gaps and workarounds.
- Create team playbooks for common rural scenarios.
Knowledge-sharing strengthens the entire case management ecosystem.
Rural healthcare may be shrinking, but the role of the nurse case manager has never been larger. With preparation, creativity, and relentless advocacy, we can ensure that injured workers in even the most remote communities receive the care and support they deserve. Your advocacy can prevent a rural claim from spiraling into chronicity.
Thank you for reading. I look forward to hearing from you about what your teams working in rural areas are doing to prepare for resource scarcity.
Here are some resources I found interesting while writing this article. Get back to me with any questions or comments. You can reach me at allewellyn48@gmail.com
What Medicaid Cuts Mean for American Hospitals: https://wamu.org/story/26/04/07/what-cuts-to-medicaid-mean-for-american-hospitals
Workers’ Compensation Overview and Issues: https://www.congress.gov/crs-product/R44580
Rural Healthcare and Community Health Outreach. CMSA Today: Issue 2 2025. file:///C:/Users/Owner/Downloads/CMSQ0424-dl.pdf
