Case Management

Workers' compensation case management focuses on returning the injured worker to work as quickly as possible since the direct and indirect costs of a claim can be high for an employer. The employer is paying not only for the medical and wage replacement benefits, but for lost productivity. The nurse case manager acts as the liaison between the injured worker, employer, claim representative, physician, and often the attorney representing the injured worker.

Case management can provide a wealth of information that may be needed later if the case becomes complicated by the necessity for surgery, home care services, or job accommodations. Case management enables and facilitates integrated treatment plans that for difficult cases are the only way to achieve the combined objectives of quality care, return to work, and cost effectiveness.

Our case managers serve as advocates and advisors to employees with a wide variety of illnesses and injury.  Our field case case management personel are credentialed professionals all focused on supporting proactive medical management needs and returning employees to work. 

Let us help you reduce the cost of illness and injury to your organization and improve return to work outcomes with an early referral to case management.  Experience the difference a passionate partner can made.

Medical Case Managers have expertise in the following areas:

• Clinical assessment
• Interviewing skills
• Medical terminology
• Medical planning and goal setting
• Musculoskeletal injuries
• Physician and ancillary provider communications
• Return-to-work coordination
• Physical therapy and work hardening coordination

Coordination of Services

• IME-Independent Medical Evaluation
• Second Opinion
• Peer Review
• Functional Capacity Evaluation

RED FLAGS FOR CASE MANAGEMENT INTERVENTION

• Relationship of accident to injury is unclear
• Medical guidelines indicate the treatment may be excessive
• Treatment plan is not clear or definitive
• Lost time over 30 days
• Indications exist for an Independent Medical Examination (IME)
• Multiple medical conditions with multiple diagnoses exist
• Treatment is unusual or excessive
• Multiple medical providers and ancillary services
• Possibility of pre-existing conditions
• Delay in return to work
• Medical and non-medical issues seem to complicate recovery
• Recovery slow without medical indication
• Medical treatment does not correlate with accident, injury or disability facts
• Treating providers have failed to provide medical information or clarification despite requests
• Failure to follow the medical treatment plan
• Unwillingness to communicate by the claimant or physician
• Unusual medical conditions
• Catastrophic injuries