Role of a PLL Associates Nurse Case Manager
PLL Associates is a company specializing in medical case management, employs nurse case managers who act as liaisons between injured workers, employers, insurance companies, and healthcare providers to facilitate optimal recovery and return to work.
We understand the importance of a streamlined process for managing employee injuries. As injury managers, we assist all parties in navigating every aspect of a worker’s compensation injury, from keeping all parties informed about the injured worker’s treatment, independent medical exams, and more.
Strategic Partnership
The adjuster and medical case managers are strategic partners in the management of a worker claiming compensation. Communication ensures efficient coordination of activities and prevents duplication of the effort and leverages each person’s area of knowledge and expertise. The Medical Case Manager acts as a liaison between the employer, medical provider and injured worker.
Objectives of the Medical Case Manager on Assigned Claims
- Return the injured worker to gainful employment and facilitate his/her maximum
medical recovery at the earliest possible dates. - Effectively manage the medical treatment ensuring that it is causally related.
- Maximize the use of preferred physicians by using providers in the network.
- Provide exceptional customer service through proactive communication.
Role of the Medical Case Manager on Assigned Files
- Provide timely review of the claim.
- Assigned to all claims that meet medical referral logic, and impact on the claim outcome is expected.
- Maintains accountability for Return-To-Work efforts and medical direction of the claim.
- Documents file via monthly written report.
- Coordinates and facilitates return to work opportunities to reduce the extent of loss time, including the development of transitional or modified duty with the employer. Utilizes creative means to shorten the lost time and achieve a timely medical resolution.
Resolution
The medical case manager will retain the claim file until the injured worker returns to sustained gainful employment and achieves maximum medical stability.
The referral will be closed when the following criteria are met:
- Injured worker has returned to work full-duty and medical stability has been achieved.
- Injured worker has returned to a permanent, modified duty job, and medical stability has been achieved.
- Medical management has reached maximum value.