Telephonic case management is the systematic evaluation of medical services, procedures, facilities for medical necessity, appropriateness and efficiency. This promotes optimal patient outcomes, reduces period of disability and assures high quality of care while controlling costs. This is an injury management program that provides early assessment and medical management for Workers' Compensation claims. The goal of the program is to direct the injured employee to appropriate care setting at the onset of the claim to reduce or eliminate unnecessary or inappropriate medical care.
A nurse facilitates the medical activity on a file with the ability to individualize the plan of care and coordinate early return-to-work strategy with the employer and medical provider.
The functions include: