Excel’s Telephonic Nurse Case Managers (TCM) assist in cases that rise to the level that require medical intervention and work in a collaborative environment with Utilization Review and the claims department.
TCM Nurse will always perform the following actions:
- Monitor medical treatment and provide active intervention to insure appropriate progress toward restoring wellness and productivity.
- Authorize ACOEM/MTUS approved medical request.
- Identify and refer to Utilization Review when appropriate.
- Provide follow up and management as needed with all parties.
- Maintain file note communication with claims professional.
- Coordinate onsite (Field) RN visits when appropriate.
Return to Work
TCM will obtain regular work status updates from the medical provider and attempt to facilitate return-to-work. If the patient is unable to return to full duty, the nurse will forward a copy of the job description to the medical provider and push for a full or modified work release. The nurse will then work with the employer and claims team to coordinate transitioning the patent to work.