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Definition and overview of case management

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RN CASE MANAGEMENT
VOCATIONAL/RTW
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PEER REVIEW
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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.

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.
 

 

Systemedic's
Case Management Services:


ON-SITE CASE MGT.

TELEPHONIC CASE MGT.

VOCATIONAL/RTW SVCS.

View full text of:
ARK. COMP LAW
ARK. COMP RULES

 

   

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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