Watch the video and read the cases of our Field Case Management winners to learn how these professionals make a difference.
The Heart of Case Management Award is a national program recognizing case managers who are highly regarded for transcending beyond their traditional job duties to improve the lives of thousands of injured employees.
Marisela Chavero, RN
A 25-year-old Spanish-speaking woman was walking across a warehouse floor when a forklift operator accidentally ran into her, knocking her down and crushing her right foot and ankle. She was sent to the local hospital’s emergency room where her foot was treated by an orthopedist. Marisela Chavero, RN, a bilingual case manager at Genex, was assigned to the case and visited the woman in her home soon after. She found the injured employee lying in her bed in extreme pain, in a small, rat-infested apartment without heat. Chavero immediately made an appointment with the foot specialist to consult with him and examine the foot. She soon discovered the orthopedist wasn’t equipped to properly treat the injury. The foot was blistering, turning black and blue and he did not prescribe proper pain medication.
Realizing the situation was dire, Chavero used her connections to transfer the injured employee to an urgent care facility to be seen by an orthopedist at a leading hospital in Houston. Here, the injured employee obtained world-class treatment by a renowned orthopedic trauma and plastic surgeon. The providers indicated if proper care had been further delayed, the woman’s foot would need to be amputated. Chavero provided translation services which helped gain the injured employee’s trust and ensured proper patient education to avoid post-op complications. Since Houston was several miles from their home, Chavero assisted in arranging hotel lodging for the employee and her husband as well as transportation and meal delivery. Later, she worked with the adjuster to find the couple a small, clean apartment in Houston close to her treating providers. Chavero also obtained donations from friends and family, providing the couple with furniture, houseware items and food. As the injured employee began to heal, Chavero secured a part-time job for her with the Boys and Girls Club, returning the woman to gainful employment just 8 months post injury, with cost savings well above 3:1 ROI.
Sandra Bernardo, RN, CCM
A 60-year old physical education teacher sustained an injury that caused her to undergo right knee replacement surgery. Unfortunately, she developed ischemia of the right lower leg and foot and a pulmonary embolism post-surgery that eventually led to an above-knee amputation. The injured employee was transferred to an inpatient rehabilitation facility where she completed an intense rehabilitation program for approximately three months and was discharged home. Injuries caused by surgery complications posed major challenges for the injured employee as she lost her independence and ability to work, which lead to mental anguish in trying to cope with these life changes.
Due to her experience in managing complex cases, Coventry case manager Sandra Bernardo, RN, CCM, was assigned to the claim and immediately began advocating for the injured worker, serving as her gatekeeper and coordinating access to various services, including rehabilitation, home health and pharmaceutical needs. Assessing health outcomes and cost containment became an intrinsic aspect of Bernardo’s role. She synchronized care with the orthopedist, vascular surgeon, psychiatrist, and pain management specialist, to ensure a multidisciplinary approach that adhered to recommended guidelines. This improved the injured employee’s recovery rate, helping her regain self-confidence and increase motivation to return to work. During inpatient rehabilitation admission, Bernardo coordinated home modifications to allow the injured employee to return home and enrolled her in a driver rehabilitation program where she learned to drive an adapted car, increasing her independence. The teacher has since returned to her previous position in a permanent modified capacity.