At
M Hayes our telephonic case managers are Registered Nurses with
a minimum
of three years clinical experience in orthopedics, neurology,
emergency room and intensive care. Our telephonic case managers
have advanced credentials such as the Certified Case Manager
or Certified Disability Management Specialist credentials. All
are experienced in multiple
workers’ compensation jurisdictions and have demonstrated
expertise in:
- Clinical
assessment
- Diagnostics
- Early
Intervention
- Light /
Modified Duty Coordination
- Length of
Disability based on established standards
- Return to
Work Coordination
- IME Coordination
- Field
Case Management Coordination
- PPO Channeling
- Facilitation
of Utilization Management
Early Intervention
It is well
known that claims cost can be significantly lowered through the use
of an early intervention, telephonic case management
model. At M Hayes we will tailor an early intervention program
to meet your claims needs and model. Whether our telephonic nurses
are working at your location on your claims system, or at our location
on our system that provides real time data to your claims system,
our early intervention process remains the same. 24 hour contacts,
determination of appropriate treatment plans, severity of diagnosis,
length of disability and early return to work is our focus.
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PPO Channeling
With the focus of ensuring quality care at the best
price M Hayes has developed relationships with Preferred Provider
Organizations
and can channel employees to quality providers resulting in medical
savings. If the customer already has a PPO network in place, the
M Hayes telephonic case managers will channel to your preferred
provider network to impact case savings.
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Independent
Medical Examinations
On
difficult cases there are times a need to clarify a diagnosis
and treatment
plan. M
Hayes' medical consultant’s can help
you with these cases by identifying board certified specialists
who can assess the claim from their area of expertise, and render
an opinion as to return to work options, length of disability,
extend of disability and anticipated maximum medical improvement.
Through our best in class medical services consultants we can assist
in providing valuable and accurate clinical information to resolve
difficult claims.
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Field Case Management Coordination
With
a highly trained clinician working the claim from day one, the
M Hayes
telephonic
case manager is able to identify the more
serious cases that may require field case management services,
either limited in scope or full. The M Hayes case manager works
in partnership with the customer to ensure the case is controlled
medically and referrals for field services are derived from the
customer. The telephonic case manager operates in these situations
consistent with the customer’s claims philosophy and
can serve as the medical liaison between field services and
the customer.
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