In 1996, Johns Eastern developed a medical management program for the use of our third party administration clients. By integrating claims adjusting, medical management, and cost containment together, every stakeholder, including the clients, have more immediate access to all claims data. This streamlines the process of working each claim from start to finish and ensures the highest standard of service.
Within this system, telephonic nurse case managers use their medical expertise to ensure that patients have access to appropriate health services, ensuring the medical procedures are necessary and beneficial to recovery and that they’re performed by the appropriate care providers.
When Does A Nurse Case Manager Make Sense
A nurse case manager can have a tremendous impact by helping employers attain better outcomes for their injured workers. Studies have shown that having a NCM on a workers’ compensation case produces a significant reduction in medical expenses as well as lost time. The nurse’s expertise and medical knowledge supplement that of the adjuster to enhance a faster return to work at a lower cost.
Nurse case managers are especially valuable in claims involving catastrophic injuries, hospitalization, and injuries to multiple body parts. They also improve service when an injured worker has multiple claims or are likely to require surgery to fully recover. Long term claims also benefit from a nurse case manager. In all of these cases, the additional oversight ensures that each and every procedure is going to have the best possible impact and that there aren’t superfluous expenses.
Benefits
Telephonic nurse case management is a pivotal tool in the world of claims management, revolutionizing the way we navigate patient care, claims management, and cost containment. By connecting claimants with experienced nurse case managers, Johns Eastern’s approach to medical management allows us to offer improved outcomes, while simultaneously reducing unnecessary costs and improving efficiency.
Triage – The value of a nurse case manager starts right at the first notice of injury. By handling the medical care on a claim from the onset, our nurses can ensure that injuries are consistent on all documentation, limiting unnecessary procedures. Nurses also direct care towards specific and appropriate physicians right away, improving return to work rate and limiting extraneous cost.
Litigation – One of the benefits of nurse case managers is the trusting relationship they develop with the injured worker. This rapport helps claimants maintain a positive outlook on their recovery, and thus lowers the chance that the claim moves towards litigation.
Communication – Our nurses acts as the liaison with all stakeholders, discussing restrictions and return-to-work or light duty work possibilities with employers, keeping adjusters notified of any changes in status, and coordinates with providers to achieve maximum medical improvement, assess the need for ongoing treatment, and address inconsistencies.
Preparation – The nurse case manager prepares all pre-certifications for surgery and other medical procedures to ensure that only appropriate, work related procedures are performed by in network physicians and that they are performed in network facilities. Any inconsistencies allow the nurse to get clarification, to further remove the risk of costly and unnecessary procedures.
