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Nurse Case Managers
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MEDICAL CASE MANAGEMENT

caduceus.jpg (3833 bytes)When an injured worker has an injury that requires lost time from work, surgery, or multiple medical complications that impede recovery, a Nurse Case Manager can be essential in making sure appropriate medical services are provided to the injured worker. An RN's experience and education can help to bridge the relationship between the insurance adjuster, medical providers and the employer for a safe and effective return-to-work program.

The Medical Case Manager is responsible for coordinating medical between the patient, carrier, employer, family, and a whole range of medical specialists, including doctors and therapists, both in and out of the hospital setting. The Nurse Case Manager will:

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Visit and evaluate the client in the home or hospital.

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Work with the treating physician to develop a medical evaluation and prognosis.

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Contact the employer to develop a plan for return to work.

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Contact consulting physicians, hospitals, etc., to arrange second opinions, pickup and delivery of medical records, X-rays, etc., in time for such consultations.

RSG has the largest staff of RNs in the state of Arizona with an average of over 20 years of experience in case management. Their mission is to direct the injured worker through the health and rehabilitation service delivery system with a goal of early return to employment. The utilization of an RN early in the injury process will:

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Reduce medical costs

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Reduce indemnity costs

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Increase control

CATASTROPHIC CASE MANAGEMENT

RSG has long specialized in managing catastrophic injuries, including:

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Brain Injury

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Spinal Cord Injury

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Major Burns

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Psychologically Traumatic Injuries, Assaults

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Terminal Illness/Disease

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Amputation or Crush Injuries

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Multiple Injuries

Our nurses have many years of experience working these types of complex cases and have longstanding knowledge of top specialists, treatments and clinics throughout the Southwest. Our nurses can help you coordinate all the specialists, therapists, care attendants, medical suppliers, social workers, pharmaceuticals, etc. Quite often, these injuries require a modification of the home and transportation needs. We can help you with that, too.

We also help the injured individual and their family to understand the nature and scope of both the injury and treatment plan. Specific goals are formulated to measure the recovery progress, all the while progressing to where an individual is considered at Maximum Medical Improvement (MMI).

Additionally, Life Care Planning is another service RSG can offer, assessing medical and related expenses over an individual's estimated lifespan.

MEDICAL/LEGAL SERVICES

RSG nurses can be effective in obtaining second opinions and independent medical evaluations for cases where it is warranted. The nurse will review the file material and schedule the appointment with a physician qualified in the area related to the injury. The RN will prepare a purpose letter to make sure all critical questions are addressed by the physician. All X-rays and medical records will be made available to the doctor so that a comprehensive report can be prepared.

LIFE CARE PLANNING

Persons who sustain catastrophic injuries that result in long-term or permanent disabilities face lifetime challenges and struggles adapting to and managing routines of everyday living. Managing their future means anticipating needs for medical care, special equipment, vocational training, etc. that require resources be available to meet those needs. RSG can perform a comprehensive assessment of the lifetime needs of the disabled person and, by documenting accurate projections of the costs necessary to meet those needs, produce a reliable, well-thought-out Plan. Costs may reflect immediate medical, therapeutic and physical equipment needs, but may also include:

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Health and strength maintenance

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Pharmaceutical and medical supplies

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Architectural renovations and transportation

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Aids to independent living

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Psychological/adjustment to disability counseling

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Education, career and leisure time

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Future medical/surgical treatment

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Potential complicating health problems and treatment

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Home or facility care and retirement

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Home furnishings and accessories

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Diagnostic testing

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Vocational/educational plan

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Orthotics/prosthetics

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Projected therapeutic modalities

24-HOUR TRIAGE

Since 2001, RSG has offered 24-hour injury triage for employers in Arizona. This offers employers, managers and their injured employees immediate assessment, treatment, recommendations and/or guidance to the nearest network medical facility. 

The great strength of this program is that it is staffed by RN's experienced in managing workplace injuries. Other similar programs are often staffed by technicians who only recycle computer generated treatment scripts.

Our Triage Nurses combine their extensive medical knowledge with emergency treatment protocols so that an employee can be assured of receiving sound, immediate treatment information. Other than calling 911 emergency assistance, the manager no longer has to make a medical decision regarding that injured employee. The Triage Nurse can assess the situation and will provide both the employee and the manager with a set of treatment instructions. If the injury appears severe enough to warrant a visit to a medical clinic, the Triage Nurse can direct the employee to the nearest network medical facility.

In addition, accurate initial documentation is obtained for work injuries. This can greatly reduce any confusion should the incident become a reportable to the workers' compensation system.

SENIOR CARE MANAGEMENT

Senior adults, whether they are living alone, in adult care homes, or in assisted living facilities, often have difficulty navigating the health care system and obtaining all the services they need to treat their multiple medical problems. They may not know what community resources are available. Their families may be far away and their support system may be limited. RSG Nurse Case Managers can assist senior clients to enjoy life more fully and worry less about the coordination of services. We will work to maintain wellness and quality of life and to help the elder person become more comfortable, secure and independent. For adult children of senior parents, a Case Manager can be their partner in the care of their loved ones.

SPANISH TRANSLATION

RSG's bilingual RNs can provide translation assistance for those individuals who speak "limited" English or Spanish only. This furthers RSG's goal of eliminating the barriers that can delay the recovery process. It assures that all involved parties remain fully informed of the nature of the injury/disability, the treatment plan and expected recovery timeline. The extensive medical knowledge of our RN enhances the value of our translation services and provides a better alternative than just an interpreter.

 

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This site was last updated December 2016