Allegiant Managed Care nurse case managers will ensure appropriate treatment in addition to focus on cost containment.
- Early case management intervention.
- Our nurse case managers will ensure the claimant is not “bounced” from provider to provider without established treatment plans and strategy.
- Our case managers will communicate with multiple providers and ensure all providers are striving for the same goal, maximum medical improvement, with the ultimate goal being return to work.
- Multiple injuries and complex diagnoses, our nurse case managers will assess the status of the claimant and suggest course of action.
- Nurse case managers negotiate with equipment providers for a reason-able and cost-effective rate for equipment rental and purchase.
- In catastrophic cases especially spinal cord injuries and closed head injuries, ensure proper treatment is being administered.
- Discuss with patients/claimants their ultimate responsibility for their own health.
- Copy and review all file information currently available.
- Immediately contact the injured employee upon receipt of file, and facilitate a meeting at the employee’s residence, or hospital, as the case warrants.
- Secure all medical information from the claimant relevant to the claim (may include prior injuries).
- Visit the employer to complete a job analysis as indicated. Please note that to be more cost-conscious, Allegiant Managed Care will maintain and update a job bank for the insured. With approval, we will also videotape each position and add it to the job bank. This provides greater under-standing of all the jobs available to the injured worker (light duty, modified duty, full duty, etc.).
- Meet the physician and develop a treatment strategy for the claimant which will ultimately result in cost savings to your client(s). By working closely with the physician, more efficient return to work can be facilitated.
- In applicable states, Allegiant recommends establishing a Physician/Provider Panel. We can review and adjust a current panel or establish a brand-new panel.
- Prepare a detailed medical report coordinating all efforts on a 30-day diary unless otherwise requested.
Allegiant Managed Care will copy all medicals, schedule the Independent Medical Examination (IME), send notification letters to all appropriate parties, and submit a detailed cover letter to the IME physician.
If the referral source is desirous of additional personal contact, our nurses will attend the IME, consult with the doctor, and prepare a narrative report.
Many of our current clientele request this additional service so they can receive immediate feedback as well as address issues that may arise during the evaluation that are not found in your file.
- Cases involving an injured worker with prior injuries and previous claims.
- Cases involving several physicians treating simultaneously for the same injury.
- Cases when treatment for the injury requires hospitalization.
- Cases involving physicians who disagree on diagnosis, prognosis, or treatment recommendations.
- Cases involving a major trauma, such as severe burns, brain injury, spinal cord injury, crush type injury, multiple fractures, etc.
- Soft tissue injuries with ongoing physical therapy beyond a reason-able length of time.
- Cases involving the treating physician’s office also providing therapy.
- Cases where pre-existing conditions could impact on the quality and time of the recovery period.
- Cases that are more than three months post-status injury and the treating physician will not provide or project physical capabilities and a return-to-work date.
- Cases involving a treating physician known to prolong therapy and delay a release to work.
- Cases where there is no panel posted and the injured worker is directing his/her treatment.