In this age of skyrocketing medical expenses, claims expenditures are scrutinized closely. Why spend money to involve a case manager? Are they worth it? Case management companies have had to evaluate their benefit in order to justify carrier expenditures for their services. Some benefits are tangible, some are not , but properly executed, Case Management DOES make a positive impact on the bottom line.
JMS Case Managers see ourselves as “stewards” in the workers compensation system with one driving force of accountability, and that is client-centered integrated care. You already know what disintegrated care looks like - It is disorganized care. No one seems to communicate in the patient's care. Diagnostics may be repeated unnecessarily, Medical records are unavailable. One doctor prescribes a medicine that conflicts with a medicine another doctor prescribed. Work status is not addressed, or light duty availablility is not communicated appropriately. Approvals take days and treatment is delayed. It's all in fragments.
Nurse case managers are uniquely qualified and positioned to process information from the medical, occupational, and claims management aspects of care, and facilitate a cohesive and progressive outcome toward a common goal – which is healing and RTW.
Any work restriction has a potential to become lost time. Things that compromise return to work must be talked about in clinic & during team planning. RTW is compromised when no LD is available, but it is equally compromised when it is available; but hasn’t been presented clearly to the physician. That’s why you need a nurse.
Understanding carrier needs, the CM nurse facilitates the physician’s treatment plan to move forward in a cost-wise and timely manner. Understanding the medical diagnosis and impact of injured worker compliance, CMs garner client trust by listening and teaching; by offering encouragement and establishing expectations. The carrier gets an update and knows what to expect and vital information needed to set reserves. That’s why you need a nurse.
The employer/employee relationship can be enhanced with the CM understanding employer demands, and the injured worker's rehabilitation needs validated. The employer gets an update and knows what to expect. That’s why you need a nurse.
We believe we have a responsibility to our customers and the injured workers we work so hard to serve. We strive to be stewards of the health care system by working honestly and with transparency - to address our customers’ concerns, questions and claim administration needs. We strive just as hard to journey with an injured worker as they navigate the WC system.
Call me to find out how JMS can work with your company.
by Cheryl A. Johnson, RN, CCM, CEAS II
Founder, CEO JMS Consulting, LLC
The JMS Way
of Case Management