Managed Care Organization

“Who’s managing your cost?”

Certified since 1994
Experienced Registered Nurse Case Managers
Strategic Physician Steerage/Networks
Proven Cost Reductions
Unsurpassed Customer Satisfaction
Nationwide Telephonic Case Management
URAC Accredited for Workers’ Compensation Utilization Management
Reducing Workers’ Compensation Costs

With the experience and capacity to help payers of any size implement a managed care program, OMCA will deliver quality medical care oversight to injured workers and reduce costs for payers. Managing programs that cover employers with as few as ten employees to those with several thousand, from small manufacturing and
repair to high tech and professional, from minor lacerations to joint replacements, the professionals at OMCA know what works and what doesn’t.

The OMCA MCO combines our select provider networks, UR/Peer Review Programs, Board Certified Physician Advisor Panels, Pharmaceutical Innovations and Registered Nurse Case Managers to help control your workers’ compensation costs. All of our professionals are dedicated to helping the employee recover and return to work as soon as possible. In Kentucky, only those employers in a certified managed care organization can direct claimants to a panel of select providers.

Case Management

Registered Nurses with case management certification are the key to any successful MCO. A prompt, safe return to work is our Case Manager’s goal for every injured claimant. All OMCA Case Mangers are registered nurses with experience and training in occupational medicine. Their role is to see that all available resources are correctly used to get the injured worker well. Throughout the process there is constant communication and interaction with the adjuster. Case Managers routinely talk with treating physicians, therapists and other providers to make sure there is a specific plan for the injured worker. They monitor the worker’s progress to see if adjustments to the treatment plans are necessary. If there are delays in expected recoveries, the Case Manager will intervene to make sure that both the provider and the injured worker are giving maximum efforts
to achieve recovery. All the members of the managed care organization, the role of the Registered Nurse Case Manager is the most important as we help payers control medical costs and case reserves.

Utilization Review

Effective UR to the highest industry standards is a critical MCO function. As a member of a select fraternity that has chosen to be URAC accredited for workers’ compensation utilization management, we have made the investment to ensure that appropriate requests are immediately approved while denials are thoroughly researched and scientifically supported. Many of our physician advisors are authors of workers’ compensation clinical guidelines and recognized nationally as leaders in their fields of medicine. URAC accreditation lets clients know that we will adhere to the highest industry standards as we help payers effectively control their medical costs and case reserves.

Client Services

A vital piece of workers’ compensation managed care is effectively training employees in their responsibilities under managed care. Reporting injuries promptly, selecting “in network” medical providers and communicating with case managers are required of all injured workers. Failure to properly use the system can result in medical bills being denied for payment.

Our Client Services department has effectively trained thousands of workers (and their supervisors) in the correct use of the managed care system. Selecting a network physician is a critical part of this process and over 96% of our initial visits are “in network” because the employee has been well trained. Training can occur at your facility on all shifts. Training material includes posters, letters and videos.

OMCA provides MCO services to carriers, third party administrators and self funded employers.

To hear more about OMCA Managed Care Organization Programs, contact Rosalie Faris, RN, BSN, CCM, COHN-S at rosalie.faris@omca.biz

From our Clients & Colleagues

Glen Mudd Louisville Water Co.

“OMCA is an easy company to work with. The only issue we’ve ever had is an employee who didn’t understand the paperwork. That’s a pretty good record.”