Medical Care Management

hospital bed

Medical case management is a collaborative process that facilitates recommended treatment plans to assure the appropriate medical care is provided to disabled, ill or injured individuals.  Whether the patient has catastrophic injuries, brain trauma or complicated medical conditions, ConniCare can provide concierge style care management in the most cost effective manner possible.

Case management is provided by a team of nurses and refers to the planning and coordination of health care services appropriate to achieve the goal of medical rehabilitation. Medical case management may include, but is not limited to, care assessment, including personal interview with the injured employee, and assistance in developing, implementing and coordinating a medical care plan with health care providers, as well as the employee and his/her family and evaluation of treatment results.

There are multiple types of medical case management that can be further defined.  Below are the major services provided by ConniCare.

Coordination of Services

Our medical case management includes working with multiple companies, physicians and other care providers to coordinate services.  Here are some of the more common coordinated services:

  • Independent Medical Evaluation
  • Second Opinion
  • Peer Review
  • Functional Capacity Evaluation
  • On-site Medical Case Management: Limited or Full
  • Assignment of DME, home health, or pharmacy needs
  • Provide Initial Case Activity report on all referrals within 24 hours
  • Contact injured person and physician within 24 hours

Referral Review – Indications for Care Management

  • Relationship of accident to injury is unclear
  • Medical guidelines indicate the treatment may be excessive
  • Treatment plan is not clear or definitive
  • Lost time over 30 days
  • Indications for an Independent Medical Examination (IME)
  • Multiple medical conditions with multiple diagnoses exist, treatment is unusual or excessive
  • Multiple medical providers and ancillary services
  • Possibility of pre-existing conditions
  • Delay in return to work
  • Medical and non-medical issues seem to complicate recovery
  • Recovery slow without medical indication
  • Medical treatment does not correlate with accident, injury or disability facts
  • Treating providers have failed to provide medical information or clarification despite requests
  • Failure to follow the medical treatment plan, unwillingness to communicate
  • Unusual medical conditions

Our Care Management Process

  • Create a personalized plan of care
  • Give you 24/7 access to a personal case manager
  • Coordinate your care with doctors, insurance, and other healthcare providers
  • Manage costs thru discount negotiation & streamlined care
  • Minimize waiting for appropriate services
  • Review your bills & ensure accurate costs