Onsite
Nurse Case Management
CaseSmartsm Medical Case Management allows for effective management of health care needs throughout the employee's episode of disability or injury.
Experienced ISYS case managers excel at coordinating effective communications and in helping to assure compliance with appropriate treatment protocols. Projecting the duration and complexity of disability and recovery allows for the assurance of timeliness, quality, necessity and cost-effectiveness of the treatment plan.
ISYS suggests the following guidelines be considered when deciding to refer a case for Onsite Case Management services:
Experienced ISYS case managers excel at coordinating effective communications and in helping to assure compliance with appropriate treatment protocols. Projecting the duration and complexity of disability and recovery allows for the assurance of timeliness, quality, necessity and cost-effectiveness of the treatment plan.
ISYS suggests the following guidelines be considered when deciding to refer a case for Onsite Case Management services:
Treatment Indicators
- Up to four weeks of ongoing disability and treatment with no resolution projected
- 2 consecutive medical reviews indicate little or no improvement with little or no change in treatment plans
- Treatment is inconsistent with the diagnosis
- Excessive (12 visits or 4 weeks) of physical therapy or chiropractic treatment without significant improvement
- Objective medical findings do not coincide with complaints or symptoms
- More than one physician involved and no resolution projected
- Surgery recommended
Diagnostic Indicators
- Spinal cord injury
- Back or neck injury
- Brain injury/head trauma
- Repetitive motion injuries
- Amputations
- Multiple fractures
- Multiple trauma
- Brachial Plexus injuries
- Diabetes
- Asthma
- Cancer
- Burns
- Exposure to severe work place conditions
- Sight/hearing defects
- Significant psychiatric trauma
Social Indicators
- Limited or no medical insurance
- Seeks physician change
- Frequently calls
- Does not comply with treatment requirements
- History of prior claims
- Questionable motivation
Economic Indicators
- Employee near retirement
- Newly hired employee
- Employee with interpersonal or home-life problems
- Job accommodations not feasible
- No job available
Claim indicators
- Litigation is likely
- Questionable claim
- MCM required by terms of coverage
- MCM mandated by legislation
