Medical Case Management

Early intervention and effective case management ensure that injured workers receive the right treatment at the right time, facilitate return to work and reduce medical and indemnity costs. Don’t let a few complex injuries adversely affect your workers’ compensation costs. Our case managers apply their years of expertise and work with you to analyze your claims. We quickly flag injuries with the potential for high costs and long claim durations, and then ensure those injuries are handled effectively to:

  • Identify the right treatment at the right time
  • Facilitate return to work
  • Reduce medical and indemnity costs
  • Limit the impact of worker injuries on your business
What We Offer:
  • A Partnership Approach
  • Four Key Benefits of Case Management
  • A Tiered Approach Drives Appropriate Intervention
  • Measuring Our Value

CareWorks Managed Care Services’ experienced medical case managers understand the triggers for difficult claims, such as complicated medical conditions, extended lost time, opioid use and repeat injuries. They partner with each client to review claims history and data and apply their expertise to your claims.

Together we will develop parameters that target the most potentially troublesome claims. This helps adjusters recognize claims that will benefit from case management before they spiral out of control. It also creates an efficient process for utilizing case management.

Our approach ensures that case management resources are applied to claims where it will truly help shorten durations and provide savings.

Because case managers speak the doctors’ language they can partner with providers to help guide care and ensure it is focused on returning the injured worker to productive status.

Case management offers four key benefits to employers and injured workers. A case manager can help:

  • Prevent “injury creep” by insuring medical treatment focuses on compensation work-related injuries
  • Assist injured workers in navigating the complex medical and workers’ compensation arenas, speeding access to treatment, recovery and return to work
  • Assist claims adjusters in understanding the medical aspects of the claim so they can manage the claim effectively.
  • Evaluate all treatment and provider options and guide the injured worker to the most appropriate and cost effective solution, such as:
    • Home-based care
    • Physical therapy
    • Rehabilitation center instead of a hospital

Early and targeted intervention is essential for better control of workers’ compensation claim costs and outcomes. Our tiered solution ensures that we target the appropriate intervention to drive the most effective use of resources and the best outcome for everyone.

Telephonic case management offers regular contacts with the injured worker, provider, worksite, and adjuster. It is the most cost effective means of assuring proper medical care coordination.

Telephonic + Task field case management is used when a targeted and limited face-to-face intervention is needed with the injured worker and/or provider.

Field Case Management is used for more complex cases that require direct contact with the patient, medical providers and employer to ensure the case receiving the right medical or vocational management and that all parties involved have a full understanding of what is happening with the injured worker. Our field case managers have extensive education and experience to ensure consistent, high-quality, face-to-face services for injured employees.

Life Care Planning, offered with or without case management, life care plans provide a comprehensive analysis of the ultimate cost of an injury.

Case management makes a difference. In a comparison of injuries receiving case management versus those without case management, we found that our case managers reduced the average disability period by 44.3 days, which is 34% less than the ODG projection.

From early triage instruction, immediate engagement with injured workers and treating physicians, followed by on-going engagement with both treating and consulting physicians throughout the course of the claim, the case managers were proactively working to ensure that appropriate, timely, and effective care was provided and that the injured workers had an advocate to guide them through the sometimes complex treatment process.

Getting injured workers back on the job saves you money and keeps your workforce productive.

Our Comprehensive Case Management Services

Our experienced case managers have extensive education in vocational injury management and comply with nationally recognized evidence-based treatment and return-to-work guidelines. Our case managers can:

  • Review medical records and documentation
  • Collaborate with physicians to coordinate care
  • Ensure compliance with nationally recognized evidence-based treatment and
    return-to-work guidelines
  • Facilitate communication among all involved parties
  • Explain medical tests, medications and terminology
  • Attend Physician appointments
  • Assist in the field with return-to-work efforts
  • Prevent the injured employee from forming a disability mindset
  • Consider pre-existing conditions
  • Evaluate medical necessity of treatment
  • Expedited medical treatment through CareWork’s own preferred provider
    organization (PPO) and diagnostic imaging and scheduling networks
  • Provide recommendations for independent peer review and independent
    medical evaluation
  • Provide specialized medical expertise
  • Create or review existing Life Care Plans
  • Explain medical tests, medications and terminology
  • Attend physician appointments
  • Expedite medical treatment through CareWorks’ own preferred provider
    organization and diagnostic imaging and scheduling networks
  • Access CareWorks’s on-staff review physicians available as needed for
    consultations or direct discussions with treating physicians
  • Review treatment plans and guidelines with adjusters to support more
    accurate reserve setting
  • Help adjusters set specific red flags to trigger additional cost management steps

A truly effective managed care solution

Our comprehensive array of managed care services deliver the right results for our clients and their injured workers.

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