This helps ensure that the injured worker has timely and coordinated access to medically appropriate levels of health services and support and continuity of care through our ongoing assessment of customer needs, while checking claim costs and ensuring that treatment goals are achieved. Gateway Health Management medical case managers provide specialized coordination of care for catastrophically injured workers. Immediately after a catastrophic injury, the patient generally cannot be an expert advocate of expert medical care … And most families are also unwilling to address the complex scenario of interdisciplinary care during its intense shock and early adaptation.
They do this and ensure that the care provided is safe, effective, customer-oriented, timely, efficient, and fair. All stakeholders benefit when clients reach their optimal level of well-being, self-care management and functional capacity. These stakeholders include clients themselves, their support systems, and care systems, including healthcare providers, employers, and various sources of payment. Catastrophic injuries pose immediate and long-term cost risks to an employer, as well as persistent physical and emotional risks to the injured employee.
For example, an employee may have suffered a traumatic brain injury, a spinal cord injury that left the person paralyzed, severe burns, or an amputation. In the future, the injury will have a dramatic impact on all aspects of that person’s life. Today, payers will often use the clinical experience of case managers to ensure that their catastrophic cases life care planning expert witness receive the specialized care and attention they need, as well as all the other services the injured worker needs to deal with a life-changing injury. If you know someone who would benefit from case management, you should send a referral by completing and faxing or faxing the medical administration nomination form to the case management department.
Professionals within or between health care organizations (p. Eg., provider, employer, payer and community agencies) and institutions work closely together for the benefit of clients / support systems. Graduated from Helene Fuld School of Nursing, Ms. Blue has extensive experience in nursing, case management, and use review. At ADM, we offer cost-effective, high-quality employee compensation solutions for employers, outside managers, insurance companies, and government agencies.
All case managers are nationally certified or eligible for case management or rehabilitation and have established relationships with major knowledge centers and regional trauma centers. Case managers improve case management services and associated results by maintaining the privacy, confidentiality, health, and safety of clients through advocacy and compliance with ethical, legal, accreditation, certification, and regulatory, as appropriate. Catastrophic injuries can occur to employers anywhere in the United States, both on the subway and in rural areas. As such, it is important to select a company with wide geographic coverage and access to hundreds of catastrophic case managers across the country.
Whether you are providing personal care services to clients, helping nursing care, or simply postponing families, we are here to help. Clients with catastrophic injuries are likely to need long-term medical care and unfortunately have difficulty returning to work and resuming activities of daily living. In addition to the physical pain and emotional impact of catastrophic injuries, the financial consequences can be overwhelming. The domain of Professional Development and Progress consists of knowledge related to the roles and responsibilities of case managers in articulating, promoting and demonstrating the value of case management practices. The Quality and Results domain Assessment and measurement consists of knowledge related to quality management, accreditation standards, quality of care and security, which demonstrate return on investment and profitability. In addition, this domain includes demonstrating the value of case management, case tax calculation, tools such as case management care plans and regulations regarding case management.
In this way, the company can assign an experienced case manager to a catastrophic injury as soon as possible. Often these case managers also have the advantage of deep regional experience, because they have already worked with intensive care centers in this area and can function as a smooth expansion of those teams. Gateway medical case managers also provide field management for chronic pain syndrome and the spectrum of industrial injuries with proactive and timely care for the unique needs of each injured worker. Employee Compensation Insurance Adjusters assign separate tasks and limited and complete field management. While few cases are problematic, high-risk, or catastrophic, those specific cases can be financially expensive and require significant resources and experience for high-quality, effective care management. As an established leader in Medical Case Management, SCM has a proven track record for delivering value in these highly complex situations.
We take the complex and facilitate it through our catastrophic case management service. In some cases, an employer may refer a client (p. Eg., injured worker at work) for occupational rehabilitation as part of the return to work plan. “This person may be a patient, beneficiary, injured employee, claimant, enrolled, member, student, resident, or healthcare consumer of any age group. In addition, the term client can also derive the recording of customer support ”(CMSA, 2016, p. 32).