Medical Case Management
Our quality case management services are effective and include;
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.
- Communication with all involved parties throughout the recovery process.
- Coordination of return to same job or alternate employment.
- Identification of contributing factors that may interfere or prevent recovery. Establishment of goal oriented treatment plans.
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.
Criteria for Referral:
1. All orthopedic injuries, brain injuries, nervous system and burns.
2. Certain chronic illnesses (i.e., emphysema, coronary artery disease, cancer).
3. High cost claims; Receipt of an interim hospital bill, indicating the potential for high cost claims.
4. Repetitive or excessive use of certain health care services, such as respiratory therapy, home health care, or physical therapy.