TELEPHONIC CASE MANAGEMENT
Medlogix’s powerful Medical Management Solutions provide Nurse Case Management for the Workers’ Compensation, Automobile and Group Health customers that we serve. Our results-oriented focus and timely evaluations have a positive impact on both the cost and duration of the claim.Â
Treatment management is initiated with triage at the time of injury and continues through all treatment paths. Communication is key. Nurse Case Managers provide constant communication with the adjuster, treating provider, employer and injured party throughout the claim. A proactive course of treatment is mutually agreed upon and an appropriate return-to-work program is implemented through a cooperative team effort.
The significant roles are employee, employer, care provider, adjuster, and the nurse case manager.Â
- The care provider team comprises medical professionals who actively assess and document patient needs and progress throughout diagnosis, recovery, and rehabilitation.
- An adjuster’s role is to make compensability determinations, set reserves and handle the financial payment aspects of the claim.Â
The role of the nurse case managerÂ
The case manager interviews the patient to assess the injury mechanism, and the injury itself, listens for inconsistencies, and follows up on any additional complaints that might not have been included in the initial review. They then make sure that the injured worker is matched with the appropriate service providers and review each case step to determine what care needs to continue or pivot to ensure forward motion on behalf of all parties.
- Helps identify appropriate providers and services throughout care
- Ensure timely and cost-effective resources are used to obtain optimum value for all parties.Â
- Follows and reviews each step to ensure proper care is administered. To improve outcomes, they also consider alternatives in the patient’s treatment plan.Â
When it comes to managing claims with prolonged or questionable treatments, a telephonic case manager can be an invaluable resource. Not only are they able to be persistent with continuous follow-up, but they can make sure the claimant is receiving the care they need.
The nurse case manager also works closely with the employer to obtain the employee’s job description with essential job tasks, so the treating provider can evaluate the worker to determine if they are capable to go back to their previous job or work in a modified or transitional duty position based on their functional abilities.