MANAGER Karen Miller
TELEPHONE   501.227.5553 OR 800.822.2680
FAX 501.227.8362 (Field Case Mgt.)
501.978.2050 (Telephone Case Mgt.)

Case Management Services

Improving clinical outcomes while containing medical expenses is more challenging today than ever before. Systemedic gives you access to a number of customized services that are cost effective in meeting the medical case management needs of your claims.

Systemedic’s medical case management program delivers value by promoting improved treatment plans, timely recovery, and a safe return to work. We manage your cases with flexibility and responsiveness to your needs.

Our RN Case Managers possess strong clinical backgrounds and hold professional credentials such as CCM, CRRN, RNP, BSN, MS, and MSE. They cover the entire state of Arkansas and surrounding border areas, and have well-established relationships with providers, enabling them to quickly obtain medical records, receive timely updates of medical status, and improve the care of the injured worker.

We can customize our case management program to support your level of need. Because not all claims require the same level of intervention, we offer a variety of solutions, from early assessment to case closure. Our case management services can be as comprehensive or as limited as you desire.

  • Telephonic Assessment, employed early on, can be used to clarify the extent of injury and potential case issues, evaluate the current and proposed treatment plan, and recommend the appropriate level of case management service.
  • Telephonic Case Management is a cost effective choice for handling cases where proactive intervention by a medically experienced RN Case Manager is desirable, but face-to-face contact is not essential. We routinely and successfully handle cases telephonically involving soft tissue injuries, rotator cuff tears, meniscal tears, herniated discs, uncomplicated fractures, and similar injuries. If serious complicating factors are discovered or develop during the course of a case, we will recommend and facilitate a seamless transition to a more intensive level of case management intervention.
  • Field Case Management is appropriate in serious, complex, or catastrophic injury cases requiring more intensive intervention and monitoring. Field Case Management services provide in-person contact with the injured worker, treatment providers, employers, and payers, as needed. Our case management staff features experienced specialists in head and spinal cord injuries, burns, and multiple trauma.
  • Alternating Telephonic and Field Case Management can be employed when a specific appointment warrants the presence of an RN Case Manager, but that level of intervention is not required on a day-to-day basis. Conversely, a claim assigned to field case management may not require attendance by an RN Case Manager at some appointments. With account approval, we can more cost efficiently manage those non-critical appointments by letter and telephone follow-up, then resume in-person intervention as warranted.
  • Short-term Focused Services may be accessed at any point in the course of a claim. These services include:
    • Coordinating second surgical opinions and Independent Medical Evaluations (IMEs)
    • Retrospective Peer Reviews
    • Negotiating Durable Equipment (DME) cost and coordinating acquisition
    • Validating and clarifying impairment ratings to assure they are clinically supported and confirm to workers’ compensation law and rules
    • Performing RN File Reviews, organizing and analyzing your file, providing a chronolocal summary of the medical data and treatment history, pinpointing any pertinent issues, and providing corresponding recommendations to address them
    • For more information about our Short-term Focused Services: Telephone 501.227.5553 or 800.822.2680

Indicators for Referral

  • Assistance needed for early assessment and clarification of extent of injury and treatment plan
  • Lost time in excess of 2 weeks
  • History of repetitive or multiple injuries
  • Return to work is a concern
  • More than 2 physicians treating
  • Appropriateness or injury relatedness of treatment is in question, or there is extended treatment of non-specific diagnosis or chronic condition
  • Injured worker expresses specific treatment concerns, such as lack of progress, difficulty communicating with treatment providers, home environment is complicating or slowing recovery
  • Current or anticipated surgery or hospitalization
  • Pre-existing unrelated medical conditions or complicating medical conditions
  • Multiple trauma, serious or multiple fractures, head or spinal injuries, severe neurological damage, etc.
  • Admission to rehabilitation facility (Case management should be in place prior to admission to document objectives and negotiate lowest per diem rate)