| 
What types of service do
you offer?
What does the nurse consultant
do?
When should I refer a file?
Do Injured Workers accept
case management?
I don’t use nurse
consultants. They become friends with the claimant, want to
treat everything and are too expensive.
What
types of service do you offer?
Click here for Services
What
does the nurse consultant do?
Actief Case Management, Inc. nurse consultants facilitate and
expedite medical care. We meet injured workers to update status
and identify any impediment to recovery. We meet medical providers
to obtain treatment plans, timelines and work status. We contact
employers, if requested, to discuss work restrictions. We update
the claim administrators. Often we coordinate appointment scheduling,
forward utilization review requests, arrange transportation
and medical supplies, obtain medical and diagnostic reports,
research and provide information to all parties.
When
should I refer a file?
You should refer a file when you are too busy to sort
out the medical status on a complicated file.
You should refer a file when you want to address
a question of causality quickly on a claim you have not accepted.
You should refer a file when the claimant has
a complicated non-industrial pre-existing medical condition.
You should refer a file when you have not been
able to obtain reports and a treatment plan from a medical provider
after several requests.
You should refer a file when the claimant is
non-compliant with the treatment plan.
You should referral a file when the claimant
has been TTD for an unusual length of time for their diagnosis.
You should refer a file when you have an important
opinion, QME, IME, AME, and want to be certain you are sending
complete and pertinent records and diagnostics to this provider.
You should refer a file when you have a claimant
with a surgery pending who is likely to require home health,
DME or transportation coordination post-operatively.
You should refer a file when medical treatment
has markedly exceeded usual treatment time frames and the reason
for ongoing treatment is not clear.
You should refer a file when medical records
indicate a plateau yet the medical provider is continuing to
treat.
Do
Injured Workers accept case management?
Most of them do. Many injured workers need assistance because
the healthcare industry is an unfamiliar setting. They might
be non-compliant with treatment and fail to follow though with
therapy, testing and office appointments because they are waiting
to be contacted and do not understand how to arrange services
for themselves. Sometimes the medical provider uses jargon causing
the claimant to seek an attorney for an answer, when their question
is not legal but actually medical. When we contact an injured
worker and explain our role they are often having a problem
and welcome our assistance. Injured workers tell us that we
save them a lot of time and exasperation.
I
don’t use nurse consultants. They become friends with
the claimant, want to treat everything and are too expensive.
Nurse consultants should be friendly and objective professionals
who clarify options and coordinate care for the claimant. Claimants
have friends and family for support. They need the nurse consultant
to be their healthcare advocate within the liability parameters
of their industrial claim. They are told that we are consulting
specifically for the accepted industrial injury and can only
facilitate authorized care related to accepted body parts. They
are told that contact with us is optional and they are not required
to work with us. Injured Workers are advised that we are present
to identify and resolve difficulties they may have during treatment
for their industrial injury.
An experienced nurse understands that “treating everything”
is not benign and can cause serious harm. Inappropriate or unnecessary
treatment can increase or cause disability. Disability limits
life choices. A skilled nurse consultant intercedes to increase
functionality, not to increase dependency.
We are mindful of our charges. Actief Case Management, Inc.
is an independent company and we are not subject to revenue
goals set by a parent company. Our nurses are compensated according
their skill as a nurse consultant rather than for meeting company
billing goals. Effective case management is cost effective.
Most of your files do not need ongoing consulting but can be
task assignments. Our nurses are encouraged to close the file
as soon as they have completed the task requested. They will
prorate charges whenever reasonable. We would rather establish
stable relationships by providing quality services for the claimant
and claims manager, than seek rapid short term revenue growth.
back to top |
