RN CASE MANAGEMENT
VOCATIONAL/RTW
PREAUTHORIZATION
PEER REVIEW
MEDICAL BILL REVIEW
LIFE CARE PLANNING
CONSULTING
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What is case
management?
Case management is a
professional process of coordinating resources and creating flexible, cost-effective
health care options, in collaboration with a treatment team, to promote
successful medical outcomes and return to work.
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Case management focuses on
the top percentile of claimants who generate approximately 50% of
health care expenditures. By providing timely, appropriate,
beneficial care coordination to this high cost group, it is possible
to positively impact outcomes and better control at least half the
claims dollars spent.
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View full text of:
ARK. COMP LAW
ARK. COMP RULES |
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Summary of current
Arkansas regulations pertaining to medical case management
Medical case managers have been utilized in Arkansas
workers' compensation for over twenty years, but increasingly so over
the past several years due to a greater emphasis on managed care and
cost containment.
Arkansas Workers'
Compensation Commission (AWCC) Rule 33 notes that an MCO "must describe
its program for medical case management." It further specifies
that "a medical case manager shall monitor, evaluate and coordinate the
delivery of quality, cost effective medical treatment and other health
care services needed by an injured employee. Medical case managers
should ensure that the injured or disabled employee is following the
prescribed medical care plan, and shall promote an appropriate, prompt
return to work. Medical case managers shall facilitate communication
between the employee, employer, insurance carrier/self-insured, health
care provider, managed care plan and any assigned vocational
rehabilitation counselor to achieve these goals." VII [6] (d1 & 2). -The
qualifications of case managers are noted in VII [6] (d3).
If you wish, you may view
the full text of Rule 33.
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