A case manager serves to assist on a claim through a collaborative process with the adjuster, injured worker and providers of medical care through assessment, planning, implementing, care coordination, monitoring and evaluation. A case manager is there to advocate on behalf of the injured worker and promote quality of care as well as cost effective outcomes by being the liaison between all parties included in the workers compensation claim.
Athens Managed Care’s case management team helps support this process through:
- Evaluation of the treatment plan
- Facilitating medical treatment
- Communicating with the medical team
- Advocating for timely return to work and maximum medical improvement
- Addressing barriers and red flags in recovery
- Assisting with cost containment
- Requesting file closure within a timely manner
Case management services available:
Telephonic case management (TCM):
A telephonic case manager helps ensure proper utilization of services and resources by interacting with the injured workers and medical providers via telephone. The nurse monitors the medical treatment to ensure the claim is handled efficiently with the goal to assist the injured worker in returning to work and obtaining maximum medical improvement.
Field case management (FCM):
A field case manager is often referred to as an on-site nurse, since the FCM work is done in person through various appointments and meetings with medical providers, the employee, employer and other vendors. While the goals may be the same as a TCM assignment, a FCM is assigned when the claim is more severe or complex and requires on-site, hands on assistance to control costs and ensure treatment remains on track and decrease delays in the injured worker’s recovery and return to work. AMC provides coverage throughout the State of California to assist all of our client’s with on-site management.
