Healthcare Solutions' telephonic and field based case management services provide sound medical alternatives that are effective and cost efficient and avoid unnecessary and inappropriate care.  Delivered by registered nurses, the program establishes claimant advocacy and channels injured patients to accessible network providers, where jurisdictionally appropriate.  Treatment is managed proactively based on guidelines designed to promote recovery and eliminate costs and in accordance with jurisdictional regulations. Healthcare Solutions’ case management program is an effective tool for managing the coordination of medical care and meeting full recovery and return-to-work objectives.

Telephonic Case Management

Healthcare Solutions’ telephonic case management program, known as Day One, is designed as an early intervention injury management program.  Immediately upon notification, dedicated telephonic case managers work to establish claimant advocacy and ensure that medically appropriate care is provided to claimants while focusing on reducing medical and indemnity costs.  At the onset of each case, registered nurses conduct an assessment of the injured worker’s medical needs and review and evaluate treatment options.  Treatment is managed proactively in accordance with protocol-based guidelines designed to promote recovery, eliminate unnecessary costs and ensure the best possible outcome for all stakeholders involved.  Medical claims are reviewed by ICD-9 code and cost to select the most appropriate network provider to utilize to meet specific injury patterns.  Geographic needs are determined and panels are developed within statutory regulations when indicated.

The Day One program is staffed by registered nurses who convey vital information to the employer, claimant and other claims professionals to proactively coordinate care.  The speed of communication eliminates lag time often associated with the management of workers’ compensation claims.  All cases are aggressively managed to meet the injured worker’s health needs while promoting quality, cost effective outcomes.

Contact a Healthcare Solutions representative to learn more about our Telephonic Case Management Services.

Field Case Management

Healthcare Solutions utilizes a dedicated team of registered nurses with local provider knowledge to provide field case management services. Nurses are results-oriented and focus on early identification and timely interventions that can influence the duration and cost of a claim. Field case managers and our panel of physicians respond to the diverse issues within the workers’ compensation, auto and disability arenas.

Field case management services include an early intervention assessment program that includes interviews with the claimant and treatment providers. Through this assessment, a determination is made on medical status, expected length of treatment, work capability and case direction recommendations.  Onsite case management services are provided by registered nurses who evaluate and coordinate medical care with the claimant’s treating providers, therapist, employer and insurance carrier. Goal directed case management ensures appropriate care and treatment in a timely, cost efficient manner. Results are geared toward full recovery and return to work for the claimant.

Field case management services include:

Medical Management

• Evaluation and coordination of medical care with the claimant's treating physician, therapist, employer and insurance carrier
• Goal directed case management assuring appropriate care and treatment in a timely, cost efficient manner
• Results geared toward full recovery and return to work for the claimant

Early Intervention Assessment Program

• Immediate control of claims with initial interview of claimant and treatment providers
• Determination of medical status, expected length of treatment, work capability and case direction recommendations

Job Analysis

• Detailed description of pre-injury position is obtained to coordinate accurate work requirements with all parties
• Exploration of employer's capacity to accommodate return to work in either a full duty or modified capacity

Physicians Panel list

• Designed to assist the employer and employee by organizing geographically accessible network providers into panels aligned with both the statutory guidelines as well as injury experience
• Physicians panel lists are consistently reviewed and maintained with the most current provider information

Cost Analysis/Lifetime Cost Projection

• Detailed reports prepared by a case manager provide projected care costs to assist claim staff in identifying the specific cost of a claim

Independent Medical Examination

• Arranged with board certified physicians whose field of expertise is related to the claim diagnosis
• Comprehensive reports are provided, communicating medical recommendations and work status to assist in expediting a claim to full recovery or settlement

Contact a Healthcare Solutions representative to learn more about our Field Case Management Services.

Vocational Case Management

Healthcare Solutions offers vocational services for managing workers’ compensation, long term disability, general liability, auto liability, medical malpractice, ADA and employment discrimination claims. Vocational counselors administer rehabilitation services to achieve successful outcomes.  Vocational case management services include vocational evaluations and testing, job placement, labor market surveys, transitional employment, testimony and social security disability assistance (SSDI).

Vocational Evaluation

• Involves an interview with the injured individual conducted by a vocational counselor
• A client profile is created including social, educational, medical and work/training histories, as well as transferable skill information that can influence employability

Testing

• Vocational testing is used to assess a person's vocational skills and educational abilities prior to engaging in a job placement program
• Testing is administered, scored and evaluated by experts in the vocational field

Job Placement

• Job placement service includes identifying alternate employment opportunities
• The injured person is notified of various job openings and vocational specialists prepare them for each appointment by supplying all relevant aspects of the available position

Vocational Counseling

• Career counseling services are available to provide improved job seeking and interviewing skills, as well as to increase motivation for employment

Labor Market Survey

• The survey provides an accurate report of an individual's economic potential after an injury
• The labor market survey report documents earning capacity and job availability within a specific geographic area

Transitional Employment

• Identifies light or modified (transitional) job sites for employer groups unable to provide a light duty program
• Provides for temporary, light or modified duty job at a non-profit agency during the claimant’s light duty phase and continues until a full duty release to pre-injury duty or maximum medical improvement is secured
• Provides placement in a job development program to assist the individual in securing competitive work within their medical restriction if a claimant cannot return to work in a full duty capacity

Testimony

• Vocational experts provide testimony on file activity
• Liability experts testify in state and federal trials

Social Security Disability Assistance

• Coordinates vocational, medical, federal regulation and application information to assist claimant in receiving SSDI award to augment Long Term Disability.

Contact a Healthcare Solutions representative to learn more about our Vocational Case Management Services.