Nurse Case Management
“Protecting the Workers’ Compensation dollar.”
At OMCA, we use the latest medical science and highest industry standards to help Workers’ Compensation payors control their medical costs and case reserves. Nurse case management services are offered to carriers, third-party administrators and self-funded employers on a nationwide basis.
OMCA’s case management goal is to facilitate quality care, appropriate specialty referral, optimal recovery and timely return to work for injured workers. The nurse case manager utilizes best medical management practices to assess, coordinate, monitor and evaluate a treating provider’s plan of care for the injured worker.
Aggressive Return to Work Approach: The earliest possible return to work is established by timely communication among the injured worker, employer, adjuster and treating provider. Modified duty, temporary alternative duty and statutory requirements are considered while working together with all parties to achieve the earliest safe return to work.
Customized Protocols: Communication is a key element for successful medical case management. OMCA will tailor communication protocols to the needs of the employer, TPA, or insurance carrier. Effective and timely communication is essential for successful claims management.
Treatment Plan Formulation: OMCA nurse case managers work with treating providers to develop and implement an effective treatment plan for the injured worker. Plans are reviewed and modified as the injured worker progresses in the recovery process.
Appropriate Referrals to Specialists: Nurse case managers monitor the progress of each injured worker to ensure they are moving toward MMI. Injured workers will not be allowed to treat indefinitely with a provider if no objective improvement is documented. Referral to an appropriate specialist will be facilitated to improve outcomes.
Diligent Medical Oversight: Nurse case managers monitor treatment for the workplace injury to ensure that it is related and medically necessary.
Prompt Adjuster Notification: Adjusters are notified of case management activity within 24 hours. Issues such as MMI and a change in work status are communicated to adjusters immediately.
Physician Advisors: Our nurse case managers are uniquely qualified to identify the appropriate physician advisors to address issues of relatedness and medical necessity, and to recommend specific concerns to be addressed during the review process.
For more information about Workers’ Compensation services, contact OMCA at (800) 633-5960 or info@omca.biz.
