Case Management

Nurse Case Management

Telephonic case management, when coordinated with field case management, provides a cost effective solution to provide prompt and concurrent review and management of the medical care of injured employees  The key benefits of a coordinated approach include:

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CareWorks MCS case managers are domiciled within ASC's offices.  Each CareWorks MCS nurse case manager has extensive experience in state regulations and jurisdictional requirements.  CareWorks MCS nurse case manager’s expertise combined with their commitment to customize a program that exceeds each client’s goals provides exceptional savings while meeting each claimants medical needs.

Case Management Helps:

  • Seek and implement prompt return to work and wellness strategies.
  • Assure appropriate medical care is received.
  • Keep communication with claimants open and constructive.
  • Identify and arrange alternative treatment settings and arrange for care.
  • Build strong relationships between our providers, clients and claimants.
  • Identify risk prevention opportunities.
  • Control the cost of claims paid.

CareWorks MCS Nurse Case Managers:

  • Review medical records and documentation.
  • Collaborate with physicians to coordinate care.
  • Facilitate communication with all involved parties.
  • Assist in the field with return-to-work efforts.
  • Consider pre-existing conditions.
  • Evaluate medical necessity.
  • Provide recommendations for Independent Peer Review and IMEs. (w/ MCMC, LLC)
  • Provide specialized medical expertise.
  • Create or review existing Life Care Plans.
  • Explain medical tests, medications, and terminology.
  • Attend physician appointments.
 

Success Stories

  1. A significant medical issue resulted in the need for a patient to receive an expensive medication for two weeks after discharge.  A nurse case management review determined that the medication was not related to work diagnosis; therefore, resulting in a customer savings of over $2000.
  2. To improve service and lower costs for Local Government Insurance Pool - a pool serving public entities throughout Tennessee - ASC contracted with CareWorks CMS for two onsite nurses to work directly with the adjusters. In the first year of our 30+ year history, case management costs were slashed $200,000.
  3. A nurse case manager worked with the light-duty program of an employer to have an injured worker returned to light-duty eight days sooner than the physician had originally planned. 
  4. We negotiated with a physician to consider an alternative treatment unit saving over $900 on the purchase.

 

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"One of the things I really like about ASC – is I do get the feeling that you guys are always happy to help." Broker for Dallas County Schools, TX