Over the past several years, healthcare costs have risen and, in particular, increased by 4.0% over the course of 2016, according to the Bureau of Labor Statistics. This increase has also affected the cost of workers’ compensation claims. In order to combat these rising expenses, Johns Eastern constantly searches for innovative ways to provide the best service possible. One of the ways we have done this is by utilizing our Nurse Case Managers telephonically.
Nurse Case Managers are responsible for driving the medical aspect of a workers’ compensation claim towards a cost-effective and mutually beneficial conclusion. They accomplish this by coordinating, from the onset of the claim, with the injured worker, the authorized treating physicians, and the claims adjuster. This early intervention strategy allows the nurse to help identify the severity of the injury and appropriate treatment protocols.
As the claim progresses, the Nurse Case Manager monitors the medical treatment to ensure the claim is handled as efficiently as possible. The goal is to assist the injured worker in returning to work and ultimately to maximum medical improvement. By closely overseeing the medical treatment, our nurses can determine whether the requested treatment is necessary and if any new complaints are causally related to the workplace accident, all while identifying potential red flags.
Our telephonic Nurse Case Managers are able to provide these comprehensive services to all of our clients, while reducing both down time and costs during the claim.
One of the major benefits of telephonic case management is the removal of geographic limitations. By engaging with the injured workers over the phone, our nurses can provide the necessary attention no matter where they are located and can continue to assist them even if they are forced to relocate over the course of their claim. Eliminating the need to travel increases our nurses productivity in handling each individual claim.
By removing the reliance on travel, costs are reduced as well. Not only are travel expenses eliminated, but so are the nurses’ time in scheduling appointments and waiting in physicians’ offices for status conferences. Following a doctor’s visit, our nurses can remotely review the medical notes and determine whether further consultation is necessary. This removes some of the redundancy in their communication with the injured employee. Our nurses are also available, without need for a meeting, to address any medical issues that might arise with the worker.
Medical expertise also has a practical effect on cost savings. Our Nurse Case Managers are fully licensed and able to focus on just the medical aspect of the claim. This oversight allows the nurse to offer proactive guidelines to help drive the claim forward. Our nurses are capable of estimating the future treatment plan and cost in order to devise a clear path to follow. This gives the injured worker clear guidelines on how to reach maximum medical improvement quickly and safely. Because of their medical background, Nurse Case Managers can anticipate any complications that might arise either from the treatment plan or any side effects related to a medication. A quick response limits the risk of these complications dragging the claim out and having long-term effects on the worker’s recovery.
Telephonic case management also offers an intangible advantage. The increased availability of our nurses allows them to develop a rapport with the injured workers and assist them as they navigate their medical care and recovery. By encouraging communication throughout the course of the claim, our nurses are able to keep abreast of any new developments while also ensuring that the employee feels supported. Having a telephonic case manager in place can limit the need for attorney involvement since the injured worker understands the condition and the treatment plan.
Field Case Management
While the benefits of telephonic case management can be significant, there are times when the assignment of a Field Case Manager is appropriate. Our nurses and adjusters are trained to identify indicators that suggest that a hands-on presence is necessary. Some of these include:
- Catastrophic injuries
- Transfer to ER for head injuries, loss of consciousness, fractures, etc.
- Anticipation of long-term care
- Physician’s treatment is outside the Official Disability Guidelines
In these instances, having a field case manager assigned to the claim can assist in facilitating appropriate medical treatment. It can also be beneficial for a nurse to attend doctors’ appointments with an injured employee to confirm that the objectives of their recovery are being met. The medical oversight of our nursing team ensures that every claim is handled appropriately and no resources are overlooked.
For more information on telephonic Nurse Case Management, speak with your claims supervisor today or contact Marketing Coordinator Brenda Bergeron at bbergeron@johnseastern.com.
