Field Case Management


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:

  • Facilitating recommended treatment plans so appropriate medical care is provided to injured, ill or disabled individuals.
  • Assessing alternate medical services for appropriateness and cost-effectiveness, based on established medical standards.
  • Encouraging injured or ill individuals to follow the prescribed medical rehabilitation treatment plan.
  • Focusing medical plans towards return to work in a safe and timely manner, taking into consideration any restrictions or residual functional limitations.


Who We Serve


  • Insurance Carriers

  • Self-Insured Employers

  • Municipalities

  • Third Party Administrators


Life Care Planning


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:

  • Recognizes the individualized needs of a worker as it relates to a disability or chronic illness.
  • Identifies associated costs of all covered needs.
  • Identifies injured worker’s functional level.
  • Yields a detailed outline of appropriate medical care to prevent further complications.
  • Outlines possible complications and associated costs thereby more accurately forecasting liability.
  • Documents present and future medical services and all associated costs in an organized, easy to read fashion.
  • Acts as basis for any settlement negotiations.


Telephonic Case Management


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:

  • Obtain medical and employment histories.
  • Establish the estimated extent and duration of disability.
  • Determine treatment goals through physician contact.
  • Evaluate in-patient hospitalization cases for alternative discharge plans and discuss these options with the patients and physicians.
  • Locate specialty providers and coordinate referrals to them.
  • Negotiate costs of services, including surgery, inpatient treatments, home care, transportation, durable medical supplies, and outpatient treatments, including physical, occupational therapy, and chiropractic care.
  • Contact employers to obtain job requirements for clients with work-related injuries to determine employment status, the physical demands of the injured employee’s job and opportunities for modified or alternative duty.
  • Facilitate communication between physicians and employers to coordinate early return to work.


Integrated Utilization Review / Telephonic Case Management


Preferred bundles together Utilization Review and Telephonic Case Management to offer a symbiotic service that insures accuracy and timeliness:


  • Claims wherein surgery is anticipated or recommended
  • Requests for MRI, CT SCAN, Discogram, Bone Scans, etc.
  • All Cases with Over 14 Days Anticipated Disability
  • Chiropractic/Physical Therapy Treatment
  • Inconsistent Medical Findings
  • Multiple Treating Physicians
  • Pre-existing Conditions: Diabetes, Hypertension, Heart Disease
  • Patient with History of Drug/Alcohol Abuse
  • Continued Treatment by Non-Specialist Beyond 45 Day

    Any unusual claim in which the Claims Examiner feels it may warrant further intervention


Utilization Review


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.


Areas Of Expertise

PREFERRED

Management Corporation


(909) 597-2167