Allied Managed Care: Nurse Manager Functions


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Medical Bill Review	Medical Case Management	Medical Provider Network/PPOs	Utilization Review

Nurse Case Manager Functions

Early Return to Work Hospital Bill Audits Life Care Planning Management Essentials Nurse Case Management Peer Review	Nurse Case Managers: Better Care, Greater Savings Allied Managed Care Nurse Case Managers quickly discern the essentials of a case, and direct it toward a rapid resolution. Their continual interaction with all those involved in a claim enables them to find the *right balance between quality medical care and cost effectiveness. Licensed nurses command professional respect* from medical providers and interact as peers with them to develop timely, realistic treatment plans for injured workers. Developing, implementing, and evaluating treatment plans for quick recovery leads to earlier case closings and lower case costs. Among many other functions, all Allied Managed Care Nurse Case Managers: Assist in determining medical causation and if a condition is work related Clarify medical diagnosis and treatment in relation to the reported injury Identify pre-existing or non-related conditions and treatment Assist in establishing reasonable treatment plans, including timeframes, measurable objectives, and costs as a *peer* with physicians and ancillary medical providers Implement and evaluate treatment plans for quick recovery and earlier case closings Continuously monitor the patient’s progress in relation to the treatment Obtain early diagnosis based on professional standards of care from the beginning of the case Direct care into the Medical Provider Networks (MPN) or Preferred Provider Organization (PPO) networks for additional savings beyond state fee schedule allowances Negotiate prices for medical treatment, equipment, and supplies Propose cost-saving alternatives to recommended treatment, while maintaining the quality of care Answer patient and provider questions and concerns, providing the *personal touch* Establish target return to work dates, medical stability dates Attain earlier permanent and stationary status, and facilitate early return to work via modified and gradual plans Coordinate regular and light duty work releases with physicians, employers, and injured workers Know the area physicians and specialists best suited for each case Schedule timely appointments and monitor patient compliance