Excel works closely with the claims team, employer, and medical community to facilitate medical intervention and early return to work (RTW). Field Case Management services will be designed to assist only with cases that rise to the level that require medical intervention.
Type of Injuries to Consider for FCM Services
- Accepted psychiatric issues
- Catastrophic injuries: Burns, head injuries, and spinal cord Injuries,
- Chronic illness
- Complicated family dynamics
- Major multiple fractures and cardiac
- No progress noted 6 weeks post-surgery
- Temporary total disability (TTD) beyond 30 days
The presence of these warning signs indicate a probable problem file where alternative interventions will be of assistance. Managing the medical aspects of disability through a Medical Case Manager will control indemnity and medical costs, speed recovery, and help to effectively adjust the claim.
Excel also encourages the use of task assignments to accomplish a specific task relating to a claim. Task type assignment will be assigned to a Field Case Manager who will complete the assignment followed by a closing report.
Role of the Field Case Manager
- Quickly evaluate the ill or injured employee’s present status.
- Facilitate use of the most appropriate treating physician, and ensure the effectiveness of the medical provider’s treatment plan.
- Extend the window of control beyond the 30 days given by the employer.
Clearly identify existing and potential barriers to progress, and provide specific recommendations for intervention.
- Ensure the needs of the employee are met to reduce the incidence of litigation.
- Apply medical cost containment and utilization management strategies.
- Develop a comprehensive medical treatment plan with the physician, patient, claims staff, and employer to positively impact the length, course, cost, and outcome of the care provided.
- Advocate for wellness and return to productivity.
- Move the employee to P&S/MMI and return to full duty.
- Provide the employer and claims staff valuable information, and empower them to make timely and well informed decisions.
- Work closely with the employer to impart a “We Care” attitude to the employee.
- Maintain a productive employee / employer relationship to maximize any potential to return to modified, light, or regular duty work as soon as possible.
- Work closely with the treating physician and ill or injured employee to achieve timely and appropriate treatment planning, cost-effective implementation, and follow through.
- Maximize medical improvement to permanent and stationary status as soon as possible.
- Create a “Sentinel Effect” wherein the physician and employee know that a qualified medical professional is personally overseeing and involved with recovery and return to work.
Excel believes a team approach with open communication is crucial to managing a claim. Because of this, Excel nurses call or email the claims administrator following each medical visit. Job analyses and modified work positions are always presented to the treating physician at each visit. Work statuses are communicated to the department manager and claim administrator. In most cases, medical appointments are set by the nurse in an effort to maintain timely treatment. Additionally, each Excel nurse has years of experience with the medical community. This firsthand knowledge provides access to physicians that may not be available with other nurse case managers.
Excel gives special attention to cost/benefit analysis. Our goal is to document real cost savings and to ensure that savings are in agreement with the client.
How to Assign a Referral
Excel provides clients with a simple referral process and offers several options that include phone, fax, email, or web referral: