CASE MANAGEMENT

An advocate for your program and the claimant’s care

As claim complexity continues to rise, so does the need for more personalized claimant care. With First MCO’s case management program, you get a direct point of contact with a comprehensive view of the claimant’s medical care to create customized return-to-work programs. For injured workers, this same point of contact can provide answers, assistance and peace of mind during a difficult time.

We offer different levels of case management that can be selected based upon the specific needs of the claim.

Field Case Management

First MCO utilizes On-site Field Case Managers for prompt coordination of effective, medically necessary treatment on catastrophic claims. Our Field Case Managers are registered nurses with various experiences in Utilization Review, Critical Care Nursing and Case Management Certifications.  These nurses are assigned for immediate coordination of care during the most acute period of the claim and are maintained until a time when the claim can be transitioned to a telephonic nurse.

Some examples of claims which should be referred for immediate field case management:

  • Catastrophic claims
  • Motor Vehicle Accident with severe injuries sustained
  • Amputation of limb as a direct result of workers’ compensation accident
  • Severe head trauma
  • Multiple injured body parts
  • Burns/chemical exposure
  • Surgical claims
  • Claims with prolonged lost days from work

Telephonic Case Management

Case management may be evaluated from four perspectives: consumer satisfaction, process, outcome, and cost effectiveness. The combination of these four methods has yielded First MCO’s case management extremely successful.

The goal of our Case Management team is to assist and monitor quality medical care to injured employees, at the same time, controlling and minimizing costs for the employers. Our team consists of licensed, registered nurses who are well trained in medical rehabilitation and have extensive workers’ compensation experience.

Sometimes, workers’ compensation claims require more than just medical treatment. Our Case Managers work closely with physicians, employees, employers and insurance adjusters from the onset of injury until maximum health is achieved. They will assess, plan, facilitate, monitor and evaluate options and services for the best possible medical treatment while containing costs.

The First MCO Advantage:

  • Single Point of Contact
  • Customized Return to Work Programs
  • Medical Director Guidance and Peer Review when appropriate
  • Real Time System Access
  • Proprietary Web-Based Case Management System
  • Customized Outcome Reporting
  • National & Internal Disability Guidelines for Benchmarking

  • Ensure appropriate care

  • Optimize recovery speed

  • Improve communication on complex claims

  • Maximize client and injured worker satisfaction

Submit a Referral:

24/7 Toll-Free: 1-800-831-9531

Intakedepartment@firstmco.com

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