User Stories & Jobs To Be Done (JTBD)

Overview

This document captures all user workflows organized by role. Each "job" represents a complete workflow that a user needs to accomplish, with specific steps and acceptance criteria.

Care Coordinator Jobs

CC-1: Receive New Claim Referral

When I receive a new claim referral from a TPA/claims adjuster I want to capture the referral information So that I can begin the intake process

Steps:

Receive referral via phone, fax, or portal
Capture: Member name, DOB, Employer, Claim #, Injury type
Verify referral completeness
Create new case in system

Acceptance Criteria:

Can create case from minimal referral info
Case assigned unique case number
Referral source tracked

CC-2: Create Member Account

When I have a new referral I want to create the member in the system So that they can receive the intake form

Steps:

Enter member demographics (First Name, Last Name, DOB)
Enter contact info (Phone, Email)
System generates member account
System links member to case

Acceptance Criteria:

Member created with minimal info
Phone number validated (US format)
Email validated if provided

CC-3: Send Intake Form to Member

When I have a member record I want to send them the intake form link So that they can complete their intake

Steps:

Click "Send Intake Form" on case
System generates unique token/URL
System sends SMS with link
System sends email with link (if email exists)
Case updated: intake_form_sent = true
Activity logged

Acceptance Criteria:

SMS delivered with working link
Email delivered with working link
Link is unique and secure
Cannot re-send to same phone < 1 hour (rate limit)

CC-4: Monitor Case Queue & Dashboard

When I start my work day I want to see my cases at a glance So that I can prioritize my work

Dashboard should show:

Pending Assignment count
Active Cases count
Sessions This Week count
High Risk count

Case Queue should show:

All cases with filters
Status, Risk Level, Assigned To
Search by member name or case number

Acceptance Criteria:

KPI cards update in real-time
Filters work correctly
Search returns results
Can click into case detail

CC-5: Review Completed Intake

When a member completes their intake I want to review the responses and AI summary So that I can assign appropriate staff

Steps:

Receive notification of completed intake
Open case detail
View intake summary (AI-generated)
Review PHQ-9/GAD-7 scores
Review risk indicators
Determine appropriate next steps

Acceptance Criteria:

Notification received within minutes
AI summary is accurate and helpful
Scores calculated correctly
Risk indicators displayed clearly

CC-6: Assign Staff to Case

When an intake is complete I want to assign a Psychologist and/or LPCC So that treatment can begin

Steps:

View available staff
Consider workload and specialization
Assign Psychologist for evaluation
(Optional) Pre-assign LPCC for treatment
Staff receives notification

Acceptance Criteria:

Can view staff availability
Assignment saves correctly
Notification sent to assigned staff
Activity logged

CC-7: Add Notes to Case

When I have an interaction or update I want to add notes to the case So that the care team has context

Steps:

Open case
Add note with timestamp
Mark note type (Internal, Shared, etc.)
Save

Acceptance Criteria:

Note appears in activity log
Timestamp accurate
Note visible to appropriate staff

CC-8: Track Authorizations

When cases are approaching session limits I want to monitor authorization status So that extensions can be requested timely

Steps:

View "Low Authorization" dashboard alert
Contact provider about extension need
Track RFA submission status
Update case when approved

Acceptance Criteria:

Alert at < 2 sessions remaining
RFA status visible on case
Authorization approvals update session counts

CC-9: Generate Compliance Reports

When a claims adjuster requests documentation I want to generate compliant reports So that claims can be processed

Reports needed:

Causation Report
Treatment Conclusion Report
Progress Summary

Acceptance Criteria:

Reports generate as PDF
All required fields populated
Reports match DWC requirements

Member Jobs

MEMBER-1: Receive Intake Link

When I'm referred for treatment I want to receive the intake form link easily So that I can begin the process

Acceptance Criteria:

SMS received with clear instructions
Link works on mobile
Link doesn't expire quickly (24+ hours)

MEMBER-2: Complete Intake Form

When I receive the intake link I want to complete the form on my phone So that my provider has my information

Form Structure (19 Steps):

Welcome & Instructions
Personal Information
Contact Information
Emergency Contact
Employment History
Current Concerns
Symptoms Assessment
Functional Assessment
Medications
Medical History
Mental Health History
Family History
Relationship History
Trauma History
Substance Use
Education & Employment
Lifestyle & Daily Routine
Treatment Goals
Additional Information
Document Upload
Safety Assessment
Consent & Signatures

Acceptance Criteria:

Form works on mobile
Progress saves automatically
Can resume if interrupted
Takes < 30 minutes to complete
Clear progress indicator

MEMBER-3: Access Member Portal

When treatment begins I want to access my portal So that I can track my care

Portal features:

View upcoming sessions
Complete check-ins
See progress charts
Contact care team

Acceptance Criteria:

Easy login (link + code)
Mobile-optimized
Clear navigation

MEMBER-4: Complete Check-Ins

When prompted (daily/weekly) I want to report how I'm feeling So that my provider can track my progress

Check-in fields:

Pain level (1-10 with emoji)
Mood level (1-10 with emoji)
Sleep quality (1-10)
Activity level
Optional notes

Acceptance Criteria:

Quick to complete (< 2 minutes)
Visual sliders/emojis
Confirmation after submit

MEMBER-5: View Session Schedule

When I need to know my appointments I want to see my schedule So that I can plan accordingly

Acceptance Criteria:

See upcoming sessions
Add to calendar option
Contact info for reschedule

MEMBER-6: View My Progress

When I want to see how I'm doing I want to view progress charts So that I stay motivated

Charts:

Pain over time
Mood over time
Sessions completed vs. authorized

Acceptance Criteria:

Charts render on mobile
Trends clearly visible
Encouraging messaging

Psychologist Jobs

PSYCH-1: View Dashboard & Cases

When I log in I want to see my workload So that I can prioritize

Dashboard shows:

Today's schedule
Pending evaluations
Cases awaiting action
Quick stats

Acceptance Criteria:

Cases filtered to my assignment
Clear priority indicators
Quick access to case detail

PSYCH-2: Review Intake & AI Summary

When I have a new evaluation I want to review the intake data So that I'm prepared for the session

Review includes:

Full intake responses
AI-generated clinical summary
PHQ-9/GAD-7 scores
Risk indicators
Employment history
Stressors (industrial and non-industrial)

Acceptance Criteria:

AI summary is accurate
All intake data accessible
Risk flags clearly visible

PSYCH-3: Document Evaluation Session

When I complete an evaluation I want to document my findings So that treatment can proceed

Session Notes include:

Session info (date, time, duration)
Member presentation
Clinical observations
Assessment findings
Risk evaluation
Diagnosis considerations

Acceptance Criteria:

Form pre-populated with context
Can enter transcript for AI analysis
Notes save reliably

PSYCH-4: Use AI to Analyze Session

When I enter session transcript I want to get AI analysis So that I can focus on clinical judgment

AI provides:

Session summary
Key themes
Goal progress assessment
Risk indicators
Recommendations

Acceptance Criteria:

Analysis completes in < 30 seconds
Output is clinically useful
Can regenerate if needed

PSYCH-5: Create Care Plan

When evaluation is complete I want to create the treatment plan So that therapy can begin

Care Plan includes:

Diagnosis (ICD-10 codes)
Presenting issues
Treatment goals (SMART format)
Interventions
Session frequency
Expected outcomes
RTW goal
Discharge criteria

Acceptance Criteria:

AI suggestions available
Can edit all fields
Plan links to case

PSYCH-6: Complete Causation Analysis

When I have sufficient information (typically session 3) I want to document causation breakdown So that claims can be processed

Causation fields:

Claim type (Physical-Mental, Mental-Mental, Mental-Physical)
Pre-existing impairment % + narrative
Non-industrial factors % + narrative
Personnel actions % + narrative
Work exposure % + narrative
Total must equal 100%
Industrial determination (>50% = Industrial)
GAF scores (Pre-injury, Initial, Current)
Clinical rationale

Acceptance Criteria:

Percentages must sum to 100%
Narrative required for each category
GAF reference visible in UI
Saves to case record

PSYCH-7: Transfer to LPCC or Keep

When evaluation is complete I want to decide treatment provider So that member gets appropriate care

Options:

Transfer to LPCC - member continues with counselor
Keep Patient - psychologist provides treatment

Acceptance Criteria:

Can select LPCC from available list
LPCC receives notification
Case phase updates
Activity logged

PSYCH-8: Complete MMI/Discharge

When treatment is complete I want to document MMI and discharge So that case can be closed properly

MMI Fields:

MMI Status
MMI Date
Permanent Impairment (Y/N)
WPI percentage
Work restrictions
RTW status
Future medical needs
Apportionment

Acceptance Criteria:

Final causation matches or updates initial
All required fields completed
Case status updates to Discharged
Reports generated

LPCC Jobs

LPCC-1: View Dashboard & Cases

When I log in I want to see my assigned cases So that I can manage my workload

Dashboard shows:

Today's schedule
Sessions to document
Low authorization alerts
Quick stats

Acceptance Criteria:

Only my assigned cases
Clear session counts
Alerts visible

LPCC-2: Review Case & Care Plan

When I receive a transferred case I want to review the care plan So that I can provide appropriate treatment

Review includes:

Member info
Diagnosis
Treatment goals
Interventions
Session history (from psychologist)
Check-in data

Acceptance Criteria:

Full care plan visible
Previous session notes accessible
Member progress tracked

LPCC-3: Schedule Sessions

When I need to schedule treatment I want to manage my calendar So that sessions are organized

Acceptance Criteria:

Calendar view of sessions
Can create new sessions
Member receives reminder

LPCC-4: Document Therapy Sessions

When I complete a session I want to document what happened So that treatment is tracked

Session Notes include:

Session info
Member presentation
Interventions used
Goal progress updates
Homework assigned
Risk assessment
Next session plan

Acceptance Criteria:

Can enter transcript for AI
Goal progress updates
PR-2 auto-generated
Session count updates

LPCC-5: Track Authorization

When sessions are running low I want to monitor authorization So that I can request extension

Acceptance Criteria:

Visual indicator of sessions remaining
Alert at < 2 sessions
Easy access to extension request

LPCC-6: Request Extension (RFA)

When more sessions are needed I want to submit an RFA So that treatment can continue

RFA includes:

Member info (pre-filled)
Sessions requested
Justification
Progress summary
Goals remaining

Acceptance Criteria:

Form pre-populates from case
PDF generates
Authorization record created
Status trackable

LPCC-7: Recommend Discharge

When treatment goals are met I want to complete discharge So that case can be closed

Discharge includes:

Discharge reason
Goals achieved
Final assessment
RTW status
Future medical needs

Acceptance Criteria:

Case status updates
Member portal access ends
Documents generated
Notification sent

Admin Jobs

ADMIN-1: Manage Users

When staff changes occur I want to manage user accounts So that access is controlled

Acceptance Criteria:

Can create/edit/deactivate users
Role assignment works
Audit trail maintained

ADMIN-2: View System Dashboard

When I need system overview I want to see key metrics So that I can monitor operations

Metrics:

Total active cases
Cases by status
Sessions this period
User activity

Acceptance Criteria:

Real-time data
Filterable by date range
Exportable

ADMIN-3: Generate Reports

When reports are needed I want to generate operational reports So that management has visibility

Report types:

Case volume by period
Provider productivity
Session metrics
Compliance status

Acceptance Criteria:

Reports generate correctly
Export to PDF/Excel
Scheduled reports (future)

Testing Status

Job ID	Description	Ready to Test
cc-1	Receive Referral	Manual
cc-2	Create Member	Manual
cc-3	Send Intake Form	Requires task-2-7
cc-4	Monitor Dashboard	Requires tasks 2-1, 2-2
cc-5	Review Intake	Requires tasks 2-5, 7-2
cc-6	Assign Staff	Requires tasks 2-5, 4-6
member-3	Complete Intake	Requires task-3-7
psych-1	Dashboard	Requires tasks 4-1, 4-2
psych-7	Causation Analysis	Requires tasks 10-4 through 10-8
lpcc-1	Dashboard	Requires tasks 5-1, 5-2