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Medical Case Management Provided by Experienced Case Managers

Explanation of Medical Case Management Services

Preferred Case Management, LLC, acknowledges the following definition of case management set forth by the Case Management Society of America:

Case management is a collaborative process which assesses, plans, implements, coordinates, monitors and evaluates options and services to meet an individual’s healthcare needs through communication and available resources to promote quality cost-effective outcomes. (CMSA 1995)

Preferred Case Management employs experienced licensed registered nurses who are Certified Medical Case Managers by the Case Management Society of America. A medical case manager is an experienced healthcare professional that is responsible for assessing the healthcare needs of injured claimants and coordinating care within the limits of covered services.

Routine services provided by PCM’s case managers are outlined in detail below:

  • Contact you by telephone, mail or a personal visit.
  • Be available to you during regular business hours to listen to your concerns, assist you in getting the medical care that you need, and answer your questions.
  • Contact your employer about the physical requirements of your work and the availability of light duty in accordance with state law.
  • Medical records review.
  • Maintain confidentiality within the limits of the law.
  • Verify your healthcare benefits with other health insurance you may have.
  • Discuss the cause(s) of your current health status and your progress in recovery with your adjuster and healthcare providers.

We have found that medical case managers, not only help to streamline the claims process, but also are often effective in avoiding or eliminating barriers to recovery and rehabilitation. Medical case managers are experienced in coordinating the type of private care required for traumatic injuries such as brain injury. They are familiar with local healthcare providers and services and can help explore options for care. In many cases they can anticipate the care, equipment and other accommodations that you may need in the course of recovery. These case management services are provided at no additional cost to you.

Senior/Geriatric Case Management Services

The benefits of our Medical Case Management to senior clients are as follows:

  • Coordination of medical care and healthcare services for clients with chronic or acute health conditions.
  • Coordination of attendant care or nursing services upon a decline in function, disability, and inability to care for oneself.
  • Case Managers assess geriatric client’s needs, provide monthly status reports, and make objective recommendations based upon information obtained from competent medical professionals.
  • Case Managers are familiar with and are experienced in locating available community resources.
  • Case Managers provide support to geographically or emotionally distant family members.
  • Case Managers are independent and are sensitive to contentious family dynamics.
  • The involvement of an elder medical case manager may assist in preventing financial exploitation or physical/mental abuse.

Catastrophic/Traumatic Brain Injury/Spinal Cord Injuries

Medical case managers coordinate the medical care for their clients with the goal of expediting their recovery and reaching maximum medical improvement. PCM has an experienced group of Certified Case Managers with a vast range of expertise managing the following kinds of injuries: catastrophic, orthopedic, psychiatric, behavioral, neurological, and brain and spinal cord trauma. Many of PCM’s case managers hold special certifications. The case managers at PCM have experience coordinating care for children, adults, and seniors/elderly. Case managers assist in controlling the costs associated with medical care by keeping the insurance companies and employers routinely apprised both over the phone and in written status reports of the client’s needs in a medical update and by obtaining the needed medical opinions to document whether other health issues are unrelated to the underlying medical claim. Our medical case managers also coordinate the necessary arrangements for treatment, therapy, surgery, discharge planning, home care, durable medical equipment, attendant care and replacement services.

Special Needs Trusts Case Management

The benefits of Professional Case Management services provided to Special Needs Trusts are detailed below:

  • Control costs by investigating available community services and cost effective options for support staff, transportation, durable medical equipment, etc.
  • Travel to client’s location to assess needs, coordinate care, and develop a treatment plan in complicated cases, including catastrophic spinal cord injuries, brain injuries, severe fractures, amputations, etc.
  • Provide periodic status reports that summarize the activities and provide ongoing recommendations.
  • Implement plans for medical treatment, therapy, support and rehabilitation, after obtaining approval from trust officials and the client or guardian.
  • Recruit and supervise competent nursing and/or other medical support staff.
  • Coordinate plans for home modification and obtain the needed approvals.
  • Obtain competitive bids for home modifications and monitor progress through completion and obtain written acknowledgement of client/guardian satisfaction.
  • Coordinate applications for Social Security Disability, along with appeals if needed.
  • Vocational testing, determination of transferrable skills, job training, and development of job leads.
  • Monitor cases via the telephone when possible.

Telephonic Case Management

PCM also offers telephonic case management services for claimants that need medical follow-up, which can be achieved without face to face contact. Case managers communicate with the claimant, adjuster, employer, and the treating physicians, as needed, with the goal of achieving maximum medical improvement and expedite a return to work, when possible.

Medical Record Review, Analysis, & Costs Projections

PCM Medical Case Managers are experienced in projecting the future medical needs of an injured client based on the client's diagnosis, medical records, payment history, life expectancy, additional medical research and our vast professional experience in the field. This service is vital in catastrophic and complex cases, where structured settlements and medical reserves need to be determined.

Expert Witness Testimony - Medical - Vocational - Disability - Nurse

PCM’s Medical Case Managers, Vocational Consultants, Social Security Application Coordinators, Nurse Case Managers, Disability Case Managers, and Home Modification Facilitators have a great deal of experience and many hold Master’s Degrees and special certifications, which make PCM’s Consultants highly qualified as medical expert witnesses to meet your legal needs. Many of PCM’s Consultants have experience testifying under oath during depositions and in court trials.