Case Management Services

 

Case Management Services

     Our quality case management services are effective and include;

 

 

  • Telephonic Case Management
  • Medical On-site Case Management
  • Catastrophic Case Management 

Telephonic/Early Intervention Case Management

Our highly-skilled registered nurses (RN) understand the importance of bringing early medical intervention to any case,  no matter the type of claim. They take charge while partnering with you, the customer,  to help control costs and facilitate an expeditious return to health and pre-injury activity for your employee.

Using well-established protocols and disability duration guidelines, the RN telephonically manages the case to closure. Within 24 hours of receiving the case, the employee, physician and employer are all contacted telephonically and an up-to-date medical status is obtained. We promise to have that information in our customer's hands within 48 hours, electronically, faxed and/or by telephone communication.

In addition to current medical information, physician's plan of care, and anticipated disability period, you will also receive the RN's recommendation for future medical management needs. Telephonic Case Management will continue until closure. If On-site case management is needed along the way, we will make the appropriate adjustments, assuming that the increase of cost of services will bring about a more long term cost-effective and timely resolution of the case.

 

Medical On-site/Disability Case Management

TQ Consultants' On-site disability management service can be the first response to an injury or illness. This service may also be identified as an essential part of the  telephonic case management process.



    The benefits of On-site case management are as follows;
  • Evaluation of current medical status and the appropriateness of the treatment plan.
  •  Identification of contributing factors that may interfere or prevent recovery. Establishment of goal oriented treatment plans.
  • Communication with all involved parties throughout the recovery process.
  • Coordination of return to same job or alternate employment.
 

Catastrophic Case Management

This service is designed for catastrophic and long-term illnesses, which can generate staggering emotional and financial costs. TQ Consultants offers a program of assessment, planning, intervention and follow-up evaluation.

Our primary goal is to provide our customers with quality care at reasonable cost.

                                                                                                           Our strategic process is simple;

  • An experienced registered nurse clarifies complex medical problems, accurately describing the patient's status.
  • The nurse consults with the attending physician and other team members to assess appropriate cost-effective treatment.
  • The nurse communicates with everyone involved in the case - employee patient, family, physician and other medical personnel.
  • Where appropriate, a family member may be specially trained to aid in the overall care plan.
  • The nurse will also assist in discharge planning, follow-up services and the coordination of any durable medical equipment need.

In catastrophic cases, TQ Consultants' professionalism and attention to detail make a significant difference in both patient care and cost effectiveness.  

 

Criteria for Referral:
1. Any serious injury or illness (i.e., spinal cord injury, severe burn, injury to the brain or nervous system).

2. Certain chronic illnesses (i.e., emphysema, coronary artery disease, cancer).

 

3. Other conditions known to require extensive medical treatment (i.e., organ transplant, amputation, neonatal disorders).

 

4. High cost claims;  Receipt of an interim hospital bill, indicating the potential for high cost claims.

 

5. Repetitive or excessive use of certain health care services, such as respiratory therapy, home health care, or  physical therapy.