medical case management
We believe the role of a medical case manager is to educate injured employees about the medical aspects of their injury, to partner with providers to develop appropriate treatment plans and emphasize early return-to-work. Our nurses serve as medical liaisons between all parties with the ultimate goal of reducing medical and indemnity costs. Many of our nurses are Certified Case Managers (CCM) or Certified Occupational Health Nurses (COHN).
RehabWest provides impact-oriented telephonic and field case management services. Our nurses work with claims examiners to establish focused goals at the onset of the referral.
Our nurses are also available for one-time task assignments. These objective-oriented assignments can be utilized to resolve a wide range of medical control issues such as obtaining work restrictions for transitional duty or obtaining medical reports.
RehabWest provides Utilization Review (UR) services to employers, claims administrators and insurance companies throughout the United States. Our objective is to provide positive clinical outcomes for injured employees coupled with cost savings for our clients. Our flexible workflow allows for customization of the program to meet client needs.
RehabWest’s UR team is comprised of clinically seasoned physicians and nurses with experience in a wide variety of specialties. Many of our physicians maintain active private practices, keeping them tuned in to constantly evolving clinical best practices.
We provide UR services in full compliance with Labor Codes and Regulations for multiple jurisdictions. This includes prospective, concurrent, retrospective, and imminent threat reviews. We also offer an appeals program and peer to peer reviews to resolve issues and move cases along.
Our UR services add value to any managed care program:
- Positive medical outcomes for injured employees by utilizing evidence based medical guidelines
- Substantial cost savings through avoidance of unnecessary and inappropriate treatment
- Customizable reports displaying requested data elements
- Thorough yet concise determinations which stand up to medical and legal scrutiny.
Excessive and chronic medication use among injured employees can result in escalating direct and indirect costs, rarely providing medical benefit. Recent studies demonstrate pharmacy costs represent 20% of the medical expenses in workers’ compensation. Many of these costs can be minimized or eliminated through clinical pharmacy reviews involving a peer to peer negotiation to develop tapering/cessation plans.
RehabWest’s Rx Intervention Program focuses on peer to peer reviews to achieve the most positive results. We document clear treatment plans to support the use of opioids with reevaluation at regular intervals as outlined in Evidence Based Medical (EBM) guidelines. This promotes the cooperation of all parties to reduce, taper and/or cease the use of harmful medications.
What clues help identify cases needing Rx Intervention?
- Excessive amounts of daily opioid use
- Employee has not returned to work after 8 weeks of disability and is taking opioids or other controlled substances
- Opioid use started beyond the acute phase of injury for no apparent reason
- Ongoing use of controlled substances with no documentation of functional benefit
- Drug use is possibly preventing employee from returning to work
- Medications are potentially being diverted
- Future Medical Award cases in which medication costs are excessive
- Medications are being prescribed by multiple physicians
- Employee urinalysis negative for prescribed drugs
- Employee refuses urinalysis
- Pending Medicare Set-Aside evaluation
ADAAA/FEHA compliance services
RehabWest Return-to-Work Coordinators provide Job Function Analysis (JFA) and Interactive Process (IP) services to support employers’ human resources and disability management programs. Performing JFAs and IPs is critical for employers to be compliant with the Americans with Disabilities Act Amendments Act (ADAAA) and Fair Employment Housing Act (FEHA).
Job Function Analysis
Our JFA format has been designed with input from experts in the field of workers’ compensation to include physicians, attorneys, employers and disability managers. Each JFA provides a thorough description of the essential and non-essential functions.
Our Return-to-Work Coordinators help facilitate and document the IP by hosting a meeting in person or telephonically. Their role as a Coordinator is to facilitate and document the process; they are outside observers and make no decisions regarding accommodations nor the need for accommodations. This gives an opportunity for the employee to provide any suggestions they may have regarding modification(s) they might need based on their work restrictions. It also provides an opportunity for the employer to determine if the suggested modification(s) can be made. Our IP Accommodation Services add value to any return-to-work or absence management program.
RehabWest specializes in the management of Cumulative Trauma Disorders by offering full service ergonomic intervention and training. Our ergonomics team offers customized services and training to meet the needs of office work environments. We evaluate individual and comprehensive workstations, recommend adjustments, make product recommendations and assist with installation. We also develop and implement ergonomic programs and provide injury prevention education.