1. The Latest and Greatest!
Case
Management
Strategies:
The Latest and Greatest!

2. Duties of the Adjuster Determine Compensability
Facilitate/Coordinate Medical Treatment
Control the Cost
Establish goals for Recovery, Return to Work and Resolution

3. Strategies Employer Involvement Employee Involvement
Medical Management
Nurse Case Management
Return to Work Programs
Surveillance
Vocational Rehabilitation

4. Employer Involvement
Establish a good working relationship with the Employer
Keep the Employer involved at every stage
Encourage Employer to communicate, document, and notify carrier of any changes or development throughout the Recovery and RTW process
Develop a RTW Program

5. Employee Involvement Keep Lines of Communication Open
Communicate goals and Expectations
Establish Goals for Return to Work
Contact Employee regularly throughout the Recovery Process
Build and Establish Trust

6. Medical Management Physician Choice Forms Medical Release 2nd Opinions
EME’s
Communication
DME Provider
Bill Review / Network Provider
PBM
MSA / Annuity

7. Nurse Case Management Catastrophic Injury Brain Injuries
Accidents involving multiple injuries
Out of State Injuries
Select Physicians

8. Return to Work Program Physician Selection Modified Duty
Restriction on Activities
Restriction on Time Worked
Establish Policies
Inform New Hires at Orientation
Complete job description for each job

9. Effective Comparison Two 60 bed facilities
Facility A – Not Committed to their RTW Program
Facility B – Fully committed to their RTW Program

10. Facility A Facility B Summary: 2008-2016 Total Premium 1,006,601.00
Losses
440,592.18
Dividends
41,501.29
Lift/Equipment
42,501.82
Summary:
Total
Premium
688,428.00
Losses
65,842.00
Dividends
244,648.54
Lift/Equipment
28,496.62

11. Surveillance
Activity
Other Employment
Background Check
Social Media

12. Vocational Rehabilitation
Job Analysis
Labor Market Survey
Job Placement Assistant
Transferable Skills Analysis
Job Retraining
Coordination of On the Job Training

13. Conclusion