Our clients depend on us to handle the complex medical issues involved in workers’ compensation claims. As their guide, we are dedicated to simplifying the managed care process. From day one, we work hard to ensure the medical aspects of each claim are organized and we develop a clear, customized plan designed to help the injured employee return to work quickly and safely. Our team is committed to providing consistent communications between all parties to drive successful outcomes.
We work closely with our clients to help them develop a sound post-injury management process. We provide resources for the documentation and investigation of a claim, and arrange for a variety of convenient options for filing a new injury report. When employers respond quickly and effectively to a workplace injury, it enhances employee confidence and cooperation with policies and best practices. Ultimately, our goal is to reduce the time away from work due to an injury. Preparation, organization and early medical intervention are key assets in accomplishing this goal.
Engaging our nurse case managers early in the process promotes improved clinical outcomes, supports return to work efforts and helps reduce our client’s loss costs. The case manager’s role includes:
Early intervention includes three important objectives:
We evaluate our performance through our internal quality program and our external URAC accreditation for case management. The goals of case management in workers’ compensation are to:
The transitional work services program is a strategic, custom-built return to work option for employers. It involves on-site physical therapy to link the recovery process to the work site and job demands to help the employee return to full duty faster. Programs like this can help employers maintain control over claims by directing their employees to great occupational healthcare.
Vocational rehabilitation is an option for injured employees when other return to work efforts are exhausted, or when the injuries are so severe that the employee will not be able to return to their original position. A vocational rehabilitation program involves a qualified rehabilitation professional meeting personally with the employee to develop a specific plan to accomplish a work-related goal, such as return to the same job, return to a different job, same/different employer, etc.
Job retention services can be used when an employee is having difficulty progressing to their former position after returning to work on transitional duty. The program requires that a claim be lost time (eight or more calendar days). Job retention services can be incorporated whether or not an employer has used transitional work services. As a part of the program, a qualified rehabilitation professional will be personally involved in field case management with the employee and their physician. Various services are provided through this program, including job analyses, job modification, on-the-job-training, physical therapy, occupational therapy, tools, supplies, etc. The benefits include cost containment for the employer and quicker return to work outcomes for the employee.
Remain at work services can be used when an employee is having difficulty progressing to their former position after returning to work on transitional duty. It is for medical-only claims where employees return to work in seven calendar days or less. This option can be incorporated whether or not employers have used transitional work services. As a part of the program, a qualified rehabilitation professional will be personally involved in field case management with the employee and the physician. Services offered through this program include job analyses, job modification, on-the-job-training, physical and occupational therapy, supplies, etc. The managed care organization, employee and employer (with the cooperation of the physician of record) must approve the program.
When an injured employee is released to modified duty by a physician, but the employer has no opportunities to accommodate the request, alternative solutions are needed to help them return to work. An offsite alternative work program can help by providing injured employees with temporary work at a not-for-profit organization in their community. The employee is able to contribute to society in a meaningful way, working within their restrictions as they recover. The program helps employers reduce overall lost time, medical costs and recovery time. Our vocational experts identify placement opportunities and oversee the transitional duty process. Our disability management team follows the employee’s treatment and recovery progress to help them transition back to full duty.
Prescription oversight is essential for effective medical management. Medication side effects can often delay a return to work, or even endanger employees once they are back at work. Through aggressive review of prescription drugs, we protect injured employees from potentially harmful combinations that could interfere with treatment and work expectations. We routinely identify instances where a questionable medication is prescribed.
Our drug utilization review team is focused on:
To help employers control medical costs, we follow the fee schedule from the Ohio Bureau of Workers’ Compensation and then provide additional savings through PPO network reductions, clinical edits on specific billed procedures and direct negotiations with providers on duration of treatment. Our medical treatment management system is tied directly to our billing system, ensuring that any bills submitted for medical treatment that are not pre-approved for the claim are not paid.