What is the Role of a Medical Case Manager?
Medical case management can be traced back to the 1920s, originating out of the fields of psychiatry and social work. Case management has continued to evolve over the years and, today, medical case managers play a critical role in getting injured workers healthy and back to work, while acting as a trusted liaison between HR teams, insurance companies, doctors and more. Let’s take a closer look at how medical case managers support multiple stakeholders in the aftermath of a workplace injury.
Air Traffic Controllers for Workers’ Compensation
While each injured worker case is unique, one thing is consistent across all of them: there are a lot of people involved, and they all have different (and sometimes conflicting) goals. Employers want to resolve each claim quickly with minimal complications. Carriers want to keep costs predictable for their customers. And while injured employees are mostly concerned with getting healthy and returning to work, recovery can often be difficult when stakeholders struggle to communicate clearly with one another.
That’s why the most effective medical case managers operate like air traffic controllers, who direct sophisticated flight patterns and coordinate safe travel. Autumn Heisler of Risk & Insurance explains that in a similar fashion, case managers keep everyone updated and on task. Heisler adds, “[They] educate injured workers on proper care, mediate between the employer and their worker, moderate the physician’s care plan, and negotiate with the employer and insurer to get the best care outcome while saving costs.”
As you can probably guess, this isn’t an easy job. In a conversation about the attributes of a successful case manager, Peggy Crabtree of The Camden Group explained that the best candidates that she has worked with were able to anticipate the unexpected, be creative in their work, and remain resourceful.
Human-to-Human Care in the Midst of a Crisis
In addition to navigating the workers’ compensation system, medical case managers serve as a calming presence when tempers flare. Not only are the stakes high for everyone involved, but historically, claims management has been incredibly impersonal. All too often, the process is spread across a long list of vendors, which ultimately frustrates a number of stakeholders.
Not surprisingly, research has shown that relationships can be a driver of more effective claims management. In a study dating back to 1996, researchers found that a group of case managers provided better care to patients and reduced costs for providers when they stepped beyond traditional relational boundaries. Another study found that strong provider-patient relationships are associated with improved quality of care. Based on these findings, it’s clear that medical case managers play two important roles: they maintain communication across a complicated network of stakeholders, and more importantly, they’re responsible for bringing a level of humanity to an otherwise impersonal process.
Here at Viscardi, we’re particularly passionate about both roles. Our clients have come to expect rapid-fire responses from us and, even more importantly, know that we’ve got the industry expertise and long-standing relationships to communicate effectively with all stakeholders. From a human-to-human perspective, each service we offer puts the people that we help — employers, claimants, and adjusters — at the center of everything we do.