Nurse Case Management
Optimized Medical Outcomes
Employee absenteeism is one of the biggest problems employers face today. Proactive intervention is sometimes needed to facilitate an employee's recovery and timely return to work.
Nurse Case Management and Return-to-Work services are aimed at accomplishing these goals. Our multidisciplinary claims team develops a case management strategy to address the issues and risks associated with all claims for a single employee. You'll work with a Nurse Case Manager who understands your work environment and capacity to accommodate disabilities. And, of course, you'll always have access to clinical expertise relevant to a particular case.
Our nurses have experience in corporate settings, backgrounds in Occupational Health and strong ties to the physician community. We foster cooperative partnerships with medical providers and often assume a coaching role, educating them about appropriate durations and providing the necessary expertise to help them define work restrictions.
In this way, we can achieve more positive medical outcomes, minimize litigation and increase productivity.
Our automated duration review system is an integral part of claims management at Matrix. Utilizing nationally recognized guidelines, this system provides us with a statistically valid data base on which to make claim management decisions as well as benchmark our client's duration experience. Further, it establishes a method to identify claims that require internal claims management intervention and medical case management.
Return-To-Work Services—Disability Claims
Matrix Nurses work together with the Medical Providers, Employers, and Employees to facilitate appropriate medical care, identify obstacles to recovery, and ultimately focus on returning an individual to work. Obstacles may include work restrictions which can result in the need for temporary or permanent modification of duty or sometimes a new job. Return-To-Work services coordinates the accommodations needed to facilitate the disabled employee's timely return to work.
Your Nurse Case Manager facilitates return to work as follows:
- The RTW nurse develops a comprehensive Job Analysis—reviewed with the employer/supervisor and the medical provider who certified the disability—that identifies the physical and/or mental requirements of the position.
- The medical provider identifies and documents the employee' s physical and/or mental limitations. These limitations are updated with every medical visit. Your RTW nurse partners with the medical provider to develop appropriate work restrictions.
- If a claimant is unable to return to his or her previous occupation, the RTW nurse partners with the employer to identify alternative placement within the organization. This consists of reviewing current and future openings in light of the claimant's capabilities and work limitations. When a potential job is identified, the nurse contacts the treating physician to review the job requirements. If the position is found to be medically acceptable, the nurse identifies the required job skills and coordinates appropriate job skill training programs. Progress is closely monitored during the first three months to ensure a successful placement for both claimant and employer.
- If internal placement is not feasible, the Matrix nurse refers the employee to vocational rehabilitation and/or outside placement to reduce Long-Term Disability exposure.
- And, if your employee is permanently disabled, we can assist him or her with application for Social Security Disability Insurance.
Nurse Case Management Services—Workers' Comp Claims
- Nurse case management services—available for Workers' Compensation claims—focus on influencing medical care by intervening with the physician to achieve maximum medical improvement and to minimize permanent disability, as well as on facilitating the disabled employee's safe and timely return to work. In addition, Nurse Case Management combined with other managed care services such as PPO networks and utilization review, help control medical costs for Matrix clients.
If the prognosis or treatment is not appropriate, we get care back on track by collecting pertinent information (e.g., patient history and concurrent conditions) from the physician and, if necessary, challenging treatment plans.
- Our Nurse Case Managers are knowledgeable in the workers' compensation laws of states we service and are able to proactively manage claimant medical care and return to work within these specific statutory constraints.