In today’s environment, the managed care aspect of claims administration is critically important. Our Total Care Division centers around our Nurse Case Managers (NCM), all of whom are licensed Registered Nurses (RN). Each NCM is aided by a clinical support system and physician peer review network to maximize the coordination of utilization management, medical management, disability management and return to work.
Our focus is to contain the financial exposure of the disability claim by unifying the most appropriate resources to positively impact the disability duration, medical utilization and quality of care for the disabled individual
- Pharmacy Management
- Providing control over medication dispensing while saving the client and injured employee time and money
- Large Case Management
- Managing multiple factors to capitalize on quality of care and cost containment for the chronic and catastrophic disability
- Utilization Review
- Addressing the medical necessity and appropriateness of proposed care
- Short Term Disability
- Implementing a plan of care for transitional return to functionality
- Negotiated Savings
- Negotiating medical service fees for the large dollar and out of network billing
- Employee Education
- Sharing the liability. An informed patient is a person involved in their own wellness and health care compliance. Patient education of disease, anatomy, diagnosis and plan of care.
Working together, the activities of our claim and medical professionals cover the full Managed Care spectrum. Using technology and interconnectivity, we ensure the delivery of the most cost-effective care for you and the most appropriate care for your employees.