Practice Standards
Mission Statement
To provide case management services through a collaborative process of assessment, planning, facilitation and advocacy promoting options and services to meet the employee’s health needs.
To promote quality cost-effective outcomes.
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Communication
We provide customized services to our clients by providing REAL TIME updates directly to the carrier and employer from all appointments. To our partners, we communicate via email, phone/voice mail, fax and written correspondence. All communication is documented and includes an action plan.
Guidelines
Account Contact: within 24 hours of referral
Attorney Contact: within 24 hours to notify of case management
- Claimant Contact
within 24 hours of referral - Initial Client Interview
within 7-10 days of referral - Medical Provider Contact
within 48 hours (by telephone and/or visit) to obtain treatment plan with anticipated medical recovery and work status or date of physician appointment. Meet with physician within two weeks to obtain treatment plan, to include projected for MMI. - Employer Contact
within 24-48 hours to obtain job description and return to work options, either modified/transitional/regular duty.
Case Management Process
Guidelines
- Assess
Complete file review, to include customer special handling instructions. Establish purpose of case management, goals, and barriers that require resolution. - Plan
Develop individualized, goal oriented treatment plan to include disability duration and return to work anticipation within 48 hours of provider contacts. - Implement
Promote goal driven and result oriented activities with interdisciplinary teamwork of providers, to include a personal assessment of injured worker at physician appointments or as directed. - Communicate
Obtain copy of job description and/or complete job analysis. Provide update after physician appointment regarding work status and to coordinate modified duty as necessary. To work collaboratively with injured worker, physician, providers of healthcare, employer, payer, and others to develop and implement a plan that meets the injured worker’s needs and goals. - Evaluate
Conduct a thorough and systematic evaluation of the injured worker’s current status using appropriate standardized tools.
Documentation
Guidelines
- Employer/Account Notification
Within 24 hours of physician appointment. - Initial Assessment Reports
Within four weeks of assignment with rehab/treatment plan or within five business days of physician appointment. - Progress Status Reports
Every 30 days with updated rehabilitation treatment plan. - Case Activity Logs/Notes
Document all case management activities regarding file. - Authorization for Release of Information
Secure signature on relevant forms as needed.
Resolution
Guidelines
- Goal Driven
- Swift and successful outcomes
- Cost control affecting claim resolution
- Quality medical care and expeditious, safe return to work
Ethics
Guidelines
- Accountable to the highest standard of conduct based on industry expectations.
- Multidisciplinary effort
- Ongoing professional development
- Comply with all applicable legal regulations
