Medical

    Field Case Management

    • Referral by phone call, first report of injury, email/scan/fax would generate a reply in first 24 hours received
    • Contact made with the injured worker within 24 hours
    • Introduction to claimant with assessment, Plan of Action (POA), attendance and coordination of medical care, services and follow-up
    • Contact/coordination with treating physicians, specialists, physical/occupational therapy, employer, attorney etc.
    • Physician/test results reporting and time frame for returning to work in light duty and/or regular duty capacity
    • Commitment to adhering to time frames and coordination with adjuster/employer regarding progress of file

    Telephonic Case Management

    • Provided for Loss time and Medical Only reporting or less severe medical cases
    • Referral by call, first report of injury, email/scan/fax referral with reply in first 24 hours received
    • Contact/Coordination with employer, treating physician, claimant and follow-up with estimated time frame for return to work
    • Case management by telephonic supervision with directives for follow-up care, time frames for return to work and projections provided for additional intervention as warranted
    • Flat fee services available
    • Time frames provided for services related to injury diagnosis so treatment plan implementation can be coordinated and supervised
    • Discussion/Coordination of services to include alternative solutions when the file is not progressing

Catastrophic Case Management

  • Catastrophic Injuries are devastating to the injured worker and his family, not to mention the employer and co-workers. Multiple injuries or dual injuries are far more common than most clinicians, case managers and families recognize. Pioneer Care Management Consultants are trained in catastrophic injuries and all components that affect the injured worker and their family.
  • Referral by call, first report of injury, email/scan/fax with reply in first 6-8 hours received with hospital visit within 24 hours
  • Continual assessment and updated Plans of Action are provided and reassessed as needed
  • Contact with patient, family, physician care team, adjuster, employer, attorney are ongoing
  • With an emphasis on evolving treatment plans, communication and updated time frames are important noting that a catastrophic situation is a fluid one
  • Our program incorporates communication with all members associated with the injured worker
  • Updating the carrier and employer are necessary for cost projections and time frames in reaching optimum level of functioning with positive outcomes

Medical Record Review

  • We offer Medical Record Review (MRR) in Pennsylvania with planned expansion in the coming year. A medical record review can address similar issues to that of an Independent Medical Examination, however, MRRs generally look at the medical necessity of care and whether such care is reasonable and appropriate.
  • A review is completed with objective and summative observations including recommendations for proceeding with continued care or closure

Ergonomic Job Hazard Analysis

  • Ergonomic Job Hazard Assessments are performed by Certified Ergonomic Evaluation Specialists (CEES)
  • Detailed evaluation of the workers duties and work environment to identify underlying injury causing factors
  • Recommendations are developed to reduce injury risk or enable a safe reintegration of a worker returning from injury
  • Video Job Description and Physical Demand Summary which provides a thorough understanding of the worker's job duties for the treating physician, or independent medical evaluator

Preliminary Cost Reserve Projections

  • Evaluate present costs of services and project future costs using analysis, demographics and present treatment plans already utilized.
  • Work with the insurance adjuster regarding planned treatment of care with projected costs outlined
  • Work with treatment providers regarding services rendered and future service costs as outlined in their treatment plan of action with time frames outlined and adhered to so that maximum level of functioning can occur with the least amount of time encountered
  • Projection plans can be updated and re-evaluated as warranted so the carrier can plan outwards towards the limit of the claim