What types of service do you offer?

What does the nurse consultant do?

When should I refer a file?

Do Injured Workers accept case management?

I don’t use nurse consultants. They become friends with the claimant, want to treat everything and are too expensive.

What types of service do you offer?
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What does the nurse consultant do?
Actief Case Management, Inc. nurse consultants facilitate and expedite medical care. We meet injured workers to update status and identify any impediment to recovery. We meet medical providers to obtain treatment plans, timelines and work status. We contact employers, if requested, to discuss work restrictions. We update the claim administrators. Often we coordinate appointment scheduling, forward utilization review requests, arrange transportation and medical supplies, obtain medical and diagnostic reports, research and provide information to all parties.

When should I refer a file?
You should refer a file when you are too busy to sort out the medical status on a complicated file.

You should refer a file when you want to address a question of causality quickly on a claim you have not accepted.

You should refer a file when the claimant has a complicated non-industrial pre-existing medical condition.

You should refer a file when you have not been able to obtain reports and a treatment plan from a medical provider after several requests.

You should refer a file when the claimant is non-compliant with the treatment plan.

You should referral a file when the claimant has been TTD for an unusual length of time for their diagnosis.

You should refer a file when you have an important opinion, QME, IME, AME, and want to be certain you are sending complete and pertinent records and diagnostics to this provider.

You should refer a file when you have a claimant with a surgery pending who is likely to require home health, DME or transportation coordination post-operatively.

You should refer a file when medical treatment has markedly exceeded usual treatment time frames and the reason for ongoing treatment is not clear.

You should refer a file when medical records indicate a plateau yet the medical provider is continuing to treat.

Do Injured Workers accept case management?
Most of them do. Many injured workers need assistance because the healthcare industry is an unfamiliar setting. They might be non-compliant with treatment and fail to follow though with therapy, testing and office appointments because they are waiting to be contacted and do not understand how to arrange services for themselves. Sometimes the medical provider uses jargon causing the claimant to seek an attorney for an answer, when their question is not legal but actually medical. When we contact an injured worker and explain our role they are often having a problem and welcome our assistance. Injured workers tell us that we save them a lot of time and exasperation.

I don’t use nurse consultants. They become friends with the claimant, want to treat everything and are too expensive.
Nurse consultants should be friendly and objective professionals who clarify options and coordinate care for the claimant. Claimants have friends and family for support. They need the nurse consultant to be their healthcare advocate within the liability parameters of their industrial claim. They are told that we are consulting specifically for the accepted industrial injury and can only facilitate authorized care related to accepted body parts. They are told that contact with us is optional and they are not required to work with us. Injured Workers are advised that we are present to identify and resolve difficulties they may have during treatment for their industrial injury.
An experienced nurse understands that “treating everything” is not benign and can cause serious harm. Inappropriate or unnecessary treatment can increase or cause disability. Disability limits life choices. A skilled nurse consultant intercedes to increase functionality, not to increase dependency.

We are mindful of our charges. Actief Case Management, Inc. is an independent company and we are not subject to revenue goals set by a parent company. Our nurses are compensated according their skill as a nurse consultant rather than for meeting company billing goals. Effective case management is cost effective. Most of your files do not need ongoing consulting but can be task assignments. Our nurses are encouraged to close the file as soon as they have completed the task requested. They will prorate charges whenever reasonable. We would rather establish stable relationships by providing quality services for the claimant and claims manager, than seek rapid short term revenue growth.

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