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.
Duration Review
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 app
ropriate, 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.
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