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Case Management

From early telephonic intervention through field, catastrophic, and vocational interventions, our highly credentialed and experienced GENEX case management staff aggressively and professionally manages each case through to its optimal medical and vocational outcome.

GENEX believes in the same case management philosophy as the Case Management Society of America (CMSA):

Case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality cost-effective outcomes.

Additionally, GENEX follows URAC Case Management Standards as well as CMSA Standards of Practice. All of our professional staff are bound by the standards and ethics of the certifications they hold (i.e., CCM, CDMS, CRC), and our quality assurance programs reflect these standards.

Medical Case Management

Throughout the telephonic case management phase, our nurses aggressively manage each case to its optimal medical outcome. However, some injured workers require a more direct case management intervention to facilitate their recovery and return to the workplace. For approximately 5-10% of all lost time cases, we recommend referral for medical field case management.

As cases are transitioned for onsite intervention, our telephonic nurses routinely collaborate with our field case managers. We expedite our field activities through the immediate sharing of all available medical and demographic information, including a summary of case management services to date. This integration of our services maintains case momentum and guarantees a consistent strategy throughout the continuum of care.

All of our medical case managers are licensed Registered Nurses (RN), with many holding master's or bachelor's degrees in nursing. Most are certified in case management, holding the designation of Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Nurse (CRRN), and/or Certified Occupational Health Nurse (COHN), with additional certifications in related fields and clinical specialties.

24/7 Nurse Triage Hotline

The most critical point at which to influence medical care, claims costs, return-to-work outcomes, and employee satisfaction is immediately after an injury.

Our approach positions a registered nurse at the point of injury, so that injured employees are channeled to the most appropriate and cost-effective level of care. Work injury reports are sent to key players, such as the employer, supervisors, human resources, claims professionals, case managers, and RTW coordinators, within minutes of a completed call.

Multicultural Managed Care Services

For over 25 years, Multicultural Managed Care Services (MMCS) has been an example of the excellence and experience GENEX provides in resolving workers' compensation and disability cases. In addition to providing onsite case management, MMCS provides national telephonic case management, recorded statements, and translations for non-English-speaking claimants.

GENEX is proud to have a robust staff of over 150 culturally competent case managers speaking over 10 languages. Our case managers are fluent in many Spanish dialects, as well as French, Chinese, and various other languages. They understand the nuances of different cultures, leading to more effective communication with patients and their families. The result is a better outcome for the patient.

For questions and requests for services, call us at 1-800-477-2078.

Quality Assurance Program

The GENEX Quality Assurance Program operates under a model of continuous quality improvement, assessing and analyzing all aspects of the case management process. Our goal is to promote continuous improvement in the delivery of medical and vocational case management services by identifying all processes and outcomes that optimally meet customer needs.

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