Medical Case Management Duties and Responsibilities

Initial Evaluation Following Injury or Diagnosis of Illness

 

Obtaining the history of the injury or illness

 

 Reviewing/evaluating the treatment plan

 

 Obtaining medical history of the claimant

 

Review of employment history, hobbies and interests

 

 Evaluate the financial status, ability to perform activities of daily living (ADL) and  family support systems of the injured individual

 

Establishing a Comprehensive Care Plan

A claimant profile which includes diagnosis, prognosis and outline of desired treatment

 Identification and scheduling with appropriate medical specialists

 Evaluation of the treatment plan

Schedule appointments for implementation/follow up of treatment plan.

Identification/Evaluation of prescribed medications and therapy

Description of any special needs involving medical equipment and assistance for their procurement through rental or purchase and delivery

Evaluation of any Psycho-social, ADL, financial and other needs for the individual with appropriate follow up

Attendance to Physician Appointments and/or Surgery

 Ensuring transportation is available for the claimant to attend physician and/or surgery appointments

 

Accompanying the claimant during their physician consultation

 

Ensuring the physician is aware of any concerns the claimant may have

 

Ensuring the claimant understands the physician's diagnosis of their injury/illness, and any instructions and recommendations regarding treatment

 

Ensuring all concerns expressed by the claimant are addressed by the physician

 

Evaluation of the appropriateness of the physician's recommendations and instructions, and follow through of any concerns

 

Assistance with Hospital/Surgery Admission and Discharge

 Follow through of preoperative consultations, testing and evaluations

 

 Follow-through with specialist consultation and treatment for any underlying disease or condition revealed through preoperative testing

 

 Ensuring the claimant follows all preoperative instructions before surgery

 

 Arranging when necessary, transportation to local or out-of-town surgery centers

 

 Assistance with completion of surgery consent forms and other surgery/admission paperwork

 

 Assistance with discharge procedures ensuring the claimant's understanding of postoperative instructions

 

 Transportation home from surgery centers

 

 Close and consistent postoperative monitoring, ensuring the claimant has home help and is progressing as expected

 

 Ensuring prior to the claimant's discharge that any prescribed medications and/or adaptive equipment is available on their return home

 

Liaison with Therapists and Regular Attendance at Therapy Sessions

 Follow-up with physical/occupational therapists to ensure claimants are attending sessions and adhering to recommended exercise and home therapy regimes.

 

 Ensuring the claimant understands the therapy instructions and is comfortable with compliance

 

 Evaluating the therapist's implementation of the treating physician's instructions and their involvement with the claimant

 

Emotional Support, Assistance with ADL and Education

 Providing "hand-holding, emotional support for the claimant and family, especially during the early and critical stages of medical rehabilitation and following catastrophic injury

 

Answering health/treatment-related questions, ensuring the claimant understands their injury/illness and the treatment plan as prescribed by their treating physician

 

Ensuring the claimant understands the correct use and dosage of prescribed medications

 

Ensuring the claimant can perform or has assistance with activities of daily living (ADL)

 

When necessary, procuring home health or homemaker services

 

Educating and coaching the claimant regarding good nutrition, wound care and any other health issue

 

Ensuring the claimant is aware that a Medical Case Manager is available at all times for consultation and assistance in times of need 

 

Keeping the claimant motivated and on-track regarding treatment and return-to-work issues through consistent monitoring, contact and support

 

Reporting and Communication

 Medical Case Managers keep the carrier and employer informed in a timely manner of all new and/or significant changes throughout the rehabilitation process

 

Medical Case Managers concentrate on establishing effective rapport with all professionals involved in the claimant's rehabilitation process to facilitate continuity of treatment and optimum care

 

A comprehensive monthly report is provided detailing the claimant's progress, physician/therapy visits and significant events - a copy is sent to the carrier, employer and attorney (if represented)