Medical Case Management
Medical Case Management 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 a personal interview with the injured employee
- Assistance in developing, implementing and coordinating a medical care plan for the injured worker with the health care providers, the employee and his/her family
- Evaluation of treatment results.
Medical case management isn’t medical care. The goal of medical case management is to help the injured individual understand all available treatment options, so they can make an informed choice.
Role of the Medical Case Manager
An injured worker is entitled to medical care and treatment that is reasonable, necessary and related to their work injury.
The employer (or carrier) is required to provide the injured worker with these medical benefits; however, the injured worker has a right to choose their physician and health care providers.
The employer/carrier must bear the cost of medical care the worker selects, but the carrier may take action to ensure the efficient delivery and proper utilization of such medical benefits.
The Medical Case Manager (MCM) is hired by the employer/carrier to medically follow, or medically manage, the injured worker.
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