Preferred provides high quality field case management services by working closely with the injured or ill employee, healthcare provider, employer, attorney and other significant parties to coordinate successful and cost-effective outcomes. Knowledge of community resources, excellent counseling techniques and timely case reporting are representative of the skills used to assist clients in attaining successful recovery, rehabilitation, and return to work. A unique balance of patient care and cost-effective strategy is applied to each and every case with precision in order to arrive at mutually beneficial conclusions for the injured worker and the insurer.
Field Case Management Duties:
Third Party Administrators
An objective analysis of an injured worker’s current and future needs as well as the associated costs is the basis of proper life care planning. The Life Care Planner possesses extensive nursing experience in acute rehabilitation and disability management.
Benefits of Life Care Plans:
An early intervention, short-term cost containment service which coordinates care and facilitates safe and timely return to work. It is most effectively used immediately following injuries. Our Telephonic Case Management (TCM) professionals are highly effective in evaluating the severity of injuries, negotiating medical costs and identifying opportunities for early return to work.
Telephonic Case Management Duties:
Preferred bundles together Utilization Review and Telephonic Case Management to offer a symbiotic service that insures accuracy and timeliness:
Continued Treatment by Non-Specialist Beyond 45 Day
Any unusual claim in which the Claims Examiner feels it may warrant further intervention
We offer prospective, concurrent and retrospective utilization review in accordance with California Regulations Labor Code section 4610. Preferred adheres to the Medical Treatment Utilization Schedule adopted by the Administrative Director (AD) of the Division of Workers’ Compensation and the American College of Occupational and Environmental Medicine Practice Guidelines (ACOEM). We make treatment recommendations utilizing medically based criteria to ensure a cost effective treatment plan is in place.
Our URAC certified Utilization Review Process is the catalyst that allows the Preferred team to excel in the management of the delicate balance between clinical and administrative care of the claim. Through our web-based technology platform and our proven experience with the new utilization review reforms we continue to provide injured and ill workers with a management team of highly skilled, like-minded health care professionals and a team of proactive administrative personnel.
Preferred provides customized solutions that ensure the best clinical practice methods for injured workers while reducing costs of medical care. Our efficient web-based utilization review system allows our medical staff to focus potentially expensive time and attention only on situations that require their expertise; while technology, effectively executes all the necessary administrative and regulatory tasks. This has resulted in a streamlined system that generates the most efficient medical review in a timely and highly cost-efficient manner. This means that our technology allows your utilization review services to be executed primarily by Qualified Physicians. The bottom line is that you will get this very necessary medical cost containment service better and faster than you would elsewhere. Through focused utilization review technology, our utilization review nurse and specialty team are able to focus heavily on our level of customer service.
Our Medical Director, oversees the entire utilization review process. All of Preferred’s reviewers are licensed Physicians, Chiropractors, Podiatrists, Dentists, Physical Therapists, Psychologists and Acupuncturists. All reviewers are domiciled and licensed in the state of review origin (when stipulated by regulations or when requested by client). Preferred is able to maintain extensive Physician based utilization review expertise due to the sheer effectiveness and technological efficiency provided through its streamlined web based utilization review system.