Medical Case Management

Management of complex injuries and conditions requires the careful planning and coordination of treatment and services from multiple medical disciplines and a wide range of suppliers and service providers. Critical considerations for effective claims decision making include determining medical care priorities, establishing treatment goals and time-frames, engaging the injured person’s full participation in the treatment plan, and managing the logistics of treatment, equipment, home care and medications. These are the traditional roles of the Medical Case Manager, whose responsibility is to facilitate positive medical outcomes through maximizing the impact of services funded by medical claim dollars.

ANS Rehab Consulting specializes in problem-focused, task-oriented Medical Case Management interventions designed to resolve obstacles to medical recovery and move cases forward.

Examples of situations where our focused Medical Case Management approach can make a positive impact include cases involving:

• Serious or multiple injuries and complicating conditions, non-stabilized
• Medical crisis necessitating additional resources
• Ongoing treatment with no apparent end-point or plan
• Different medical specialties treating the same conditions with no coordination
• Psychological or social issues interfering with treatment
• Planned major surgery, hospital treatment or discharge
• Needed special home services or modifications
• High claim reserves requested or medical expenditures expected to approach reinsurance thresholds

Our CCM, CDMS or CRRN Nurse Case Managers work telephonically and in the field to accomplish the tasks assigned, working closely with our clients and their assigned case managers to coordinate care, obtain needed services, identify additional resources and resolve the issues necessitating referral. Once the task is accomplished or the problem is resolved, our involvement is concluded unless further intervention is requested. This approach maximizes the impact of the case management effort in general, while reducing claim costs.  

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