Telephonic Case Management
Procura’s telephonic case management program, known as Day One, is designed as an early intervention injury management program. Immediately upon notification, dedicated telephonic case managers work to establish claimant advocacy and ensure that medically appropriate care is provided to claimants while focusing on reducing medical and indemnity costs. At the onset of each case, registered nurses conduct an assessment of the claimant’s medical needs and review and evaluate treatment options. Treatment is managed proactively in accordance with protocol-based guidelines designed to promote recovery, eliminate unnecessary costs and ensure the best possible outcome for all stakeholders involved. Medical claims are reviewed by ICD-9 code and cost to select the most appropriate network provider to meet specific injury patterns. Geographic needs are determined and panels are developed within statutory regulations when indicated.
The Day One program is staffed by registered nurses who convey vital information to the employer, claimant and other claims professionals to proactively coordinate care. The speed of communication eliminates lag time often associated with the management of claims. All cases are aggressively managed to meet the claimant’s health needs while promoting quality, cost-effective outcomes.
Program features and benefits:
- Experienced RNs work diligently to establish claimant advocacy and channel injured workers to accessible network providers.
- Treatment is managed proactively in accordance with protocol based guidelines designed to promote recovery and eliminate unnecessary costs.
- Work status is addressed by the physician at the time of injury to secure a prompt return to work.
- Provider Panel Development: Medical claims are reviewed by ICD 9 and cost to coordinate the most appropriate network providers to meet specific injury patterns. Geographic coverage needs are determined and panels are developed within statutory regulations implemented when indicated.
- Employer installation: Procura will perform employer installs to gain further insight into the present operations and identify roles and responsibility for the program. Clear and effective communication is the key to a successful managed care program. Panel development and workflows are clearly outlined with timelines making expectations clear and measurable.
- First Report of Injury: Dedicated, seasoned representatives provide quick response time with accurate data integrity. Immediate channeling to network providers affords optimum care and savings.
Contact a Procura representative to learn more about our telephonic case management programs.
