NCAComp has a staff of six registered Nurse Case Managers who provide case management services to our clients. The department is overseen by an expert in both claims and case management.
Clients are provided with regular case updates, as well as summaries of the work to be performed and completed during opening and closure reports.
Telephonic Case Management
Telephonic Case Management is a great tool for complex claims, especially surgical claims or claims where the claimant may be malingering. When working telephonically, a registered nurse will coordinate with the injured worker, their employer and the medical provider. They can expedite treatment, assist in return to work, and provide valuable assistance to an injured worker and their families, in addition to providing the services that are described below.
Field-Based Case Management
Field-based case management is where a registered nurse case manager accompanies an injured worker to their medical appointments and is able to interact face-to-face with the treating provider and injured worker. By participating in-person, the nurse case manager can often make more of an impact on a case and help facilitate fast and accurate conversations about the course of a claim, including medical treatment and return-to-work options. Field-based case management is also the best option for catastrophic claims, where the medical is developing quickly and the family of the injured worker can be assisted with additional support and information from the nurse.
A nurse case manager is able to review the pharmaceutical usage on a claim and determine if the treatment is within medical treatment guidelines or is being provided at the lowest possible cost to the claim. If it is determined they can make an impact, the nurse case manager will work with the treating provider to adjust the pharmaceutical usage to more appropriate levels or work to switch usage to any available generic versions of the medication.
Utilization Review Services
The case manager is able to review all medical treatment on the file to look for an opportunity to save money or to provide a more appropriate medical plan for the injured worker. This may include the avoidance of surgery or adjustment of a long-term treatment plan to bring it in line with medical treatment guidelines.
Medical Care Cost Negotiation
Often in workers’ compensation, long-term care is needed. In these circumstances, a registered nurse case manager may negotiate for lower cost rates on inpatient facility stays or medical equipment rental or supply. These negotiated rates have saved our clients hundreds of thousands of dollars over the lives of their claims.