It refers to the planning and coordination of health care services appropriate to achieve the goal of medical rehabilitation. Medical case management may include, but is not limited to, care assessment, including personal interview with the injured employee, and assistance in developing, implementing and coordinating a medical care plan with health care providers, as well as the employee and his/her family and evaluation of treatment results.
In medical case management, a medical case manager (MCM) assesses the individual’s case for its appropriateness and cost-effectiveness, based on accepted medical standards of care. MCMs help the individual make informed choices about medical care by communicating the prescribed medical and rehabilitation treatment plan so that the person can return to work in a timely and safe manner while knowing any limitations.
An MCM is normally hired by an employer or insurance carrier to follow or manage the injured worker medically. Most medical case managers are registered nurses (RNs)
Medical case management requires the evaluation of a medical condition, developing and implementing a plan of care, coordinating medical resources, communicated healthcare needs to the individual, monitors an individual’s progress and promotes cost-effective care.