Telephonic
Nurse Case Management
Telephonic case management is a proactive process of medical and disability management. By applying strong and effective communication skills, timely and constructive case resolution can be achieved.
Telephonic Case Management Indicators
- Medical only claims requiring on-going physician visits or treatment
- Immediate upon time loss from work
- No documentation or treatment plan and/or lack of return to work (RTW) date
- Lack of medical information and/or reports from treating physicians
- Treatment plan is unclear, confusing or possibly inappropriate for injury
- Anticipated surgery
- Chiropractic or treatment by unconventional modalities
- Need for second medical opinion or referral to a specialist
- Repetitive injuries or cumulative trauma
- Coordination of multiple diagnostic tests, therapies, DME or home health services
- Soft tissue injuries resulting in loss of time from work
- Injured workers' non-compliance with treatment requirements
