Restoring Lives: 2021 Heart of Case Management Awards
Winners of top case management award help injured employees move beyond tragedy and return to meaningful standards of living
WAYNE, PA - September 22, 2021 -As the world continues to emerge from the COVID-19 pandemic, Genex and Coventry case managers are utilizing their extensive knowledge and sharp critical thinking skills to return injured employees to America's workforce in a safe and efficient manner.
These skills were evident in the nominations received for the 6th annual Heart of Case Management Award, which was expanded this year to include hundreds of Coventry case managers as well. The seven winners selected truly represent the best of these individual acts of excellence.
The Genex Heart of Case Management Award recognizes seven case managers who have made the greatest impact on the injured employees they served. The national program recognizes Genex and Coventry case managers who are highly regarded for transcending beyond their traditional job duties to improve the lives of thousands of injured employees each year. The seven winners were nominated from a field of more than 2,000 case managers across the country and judged on the following criteria: specialist, excellence, adaptability, trust, influential communication, critical thinking and outcomes.
Among this year's winners is a case manager who was integral in guiding care coordination of a police officer who was shot on duty, allowing him to recover from his critical injury and eventually return to his post. Two other case managers put their critical thinking skills to use by managing significant injuries during COVID lockdowns that kept them from being by the side of their claimants. Another helped a new amputee regain her independence and confidence to return to gainful employment
The following are synopses of the winning entries. To learn more about the winners, click on the links below.
Catastrophic Case Management
Debbi Gillespie RN, CCM
A 51-year-old police officer was shot in the thoracoabdominal region while trying to apprehend a suspect on felony warrants. The officer was quickly transported to a trauma center for emergency treatment with significant injuries including lung, liver and kidney lacerations. He underwent numerous procedures and surgeries. Over the course of his recovery, the officer required multiple readmissions to the hospital for complications and additional surgeries. Debbi Gillespie took over case management responsibilities four months after, due to her catastrophic case management expertise. She was integral in managing timely outpatient treatment to address all needs related to his injuries, and effectively coordinated multiple admissions and discharges from acute care that addressed significant liver, renal, diaphragm injuries, accumulation of liquid in the lungs and potential sepsis concerns. Gillespie's depth of knowledge in community resources enabled her to identify providers to address the physical injuries, as well as social and psychological aspects of this case, which resulted in the injured employee returning to the police force ahead of ODG guidelines. The officer's recovery won him the Rehabilitant of the Year Award from Arizona Workers' Compensation Claims Association, who praised Gillespie's successful case management in support of his return to work. The officer and Gillespie were also heralded at the Comp Laude Awards and Gala, an annual event that honors the outstanding contributions of individuals and case managers in the workers' compensation industry.
Jeaninne Powell, RN, CCM
A boom truck slid off the road, rolling over several times before landing in an embankment and catching fire. The unconscious driver was pulled from the flaming wreckage by a passerby and air transported to a hospital. After sustaining multiple traumatic injuries including spleen and liver lacerations, as well as critical burn injuries that covered nearly half his body, the man's likelihood of survival was low. The injured employee continued to face an uphill battle, surviving two cardiac arrests, multiple surgeries for burns and grafting, as well as a tracheostomy. The case was assigned to seasoned case manager Jeaninne Powell, RN, CCM. Though COVID-19 lockdown prevented her from interacting with the patient and staff directly, Powell utilized her knowledge of the hospital staff and deep expertise to arrange for timely scheduling and communication. Powell kept in constant communication with the injured employee's wife by phone, providing emotional support and education on her husband's condition. As the case progressed and the man began to stabilize, Powell developed a trusting relationship with the injured employee through phone conversations. When he resisted a recommendation to transition to a long-term acute care facility, it was Powell who convinced him to go. Through her guidance, he was able to progress from a wheelchair to ambulating with a cane in just four months. Powell facilitated his home care needs and utilized ODG guidelines to develop a realistic plan for the injured employee to return to work. Powell closed the file in just seven months, returning the man to modified duty, with an ROI of 6.31 percent.
Field Case Management
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 renown 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 eight 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. Coventry case manager Sandra Bernardo, RN, CCM, was assigned to the claim due to her experience in managing complex cases. She immediately began advocating for the injured employee, 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 resumed her previous position in a permanent modified capacity.
Telephonic Case Management
Tammy Zivic, RN, CCM
A 63-year-old hardware store employee approached two men who had left the building without purchasing items. After requesting to see a receipt, the employee was struck several times by the men with a crowbar. The attack resulted in multiple injuries, the most significant a dominant side rotator cuff tear/biceps rupture. Genex telephonic case manager Tammy Zivic was assigned to the case, promptly making contact with the injured employee. She soon learned the injured employee was experiencing excruciating pain and anxiously awaiting MRI authorization. Zivic quickly discovered a delay in payer approval for diagnostic testing and facilitated obtaining the MRI order. She forwarded it to the adjuster while assertively communicating the sense of urgency with support provided by ODG. The MRI was approved, and the results confirmed significant shoulder injuries sustained in the attack. When surgical intervention was recommended, Zivic reviewed guidelines and provided support for authorization. Postoperatively, she worked with the injured employee to address any psychological concerns related to the attack and facilitated timely weaning of narcotic medication. After full-duty release, the injured employee began to develop numbness in his fingers and right arm. Zivic communicated this information to the man's physician who prescribed bracing at night which alleviated this issue. By engaging the correct resources in a prompt manner, the case manager was critical in facilitating the care needed on behalf of the injured employee, working through delays in authorizations while in the midst of a pandemic. Zivic's actions resulted in a successful return to work prior to ODG estimated length of disability, saving 196 days in indemnity costs.
Caroline Sauve Rutledge, RN, BSN, CCM
It was a late Friday afternoon when Caroline Sauve Rutledge, RN, BSN, CCN, received a call from an adjuster assigning her to a case. The adjuster was growing frustrated after desperately trying to schedule an injured employee for hernia repair and needed help. Suave Rutledge immediately accessed the PPO network, contacted a specialist and scheduled the surgery within 30 minutes. She then updated the adjuster and injured employee about the surgery and suggested next steps to progress the claim. Utilizing ODG guidelines to ensure treatment was appropriate and timely, Suave Rutledge communicated the injured employee's job description to the surgeon so that return-to-work planning could begin post-surgery. In addition to timely communication with all parties, Suave Rutledge ensured the injured employee was well educated and prepared for his recovery via phone, email and Healthwise Coach & Communicate educational material. Without Suave Rutledge's diligence and quick action upon claim assignment, the injured employee's care could have been delayed and possibly deferred to an out-of-network provider, resulting in additional costs. By managing this file proactively and advocating for the injured employee through surgery and recovery, she helped facilitate an early return to work within weeks following surgery.
Disability Case Management
Nancy LeBlanc, RN, CCM, CPDM, WES
A 49-year-old plant operator tripped and fell into asphalt resulting in substantial bilateral arm burns, including extensive burns to both hands, right forearm and abdomen. The man was rushed to a nearby facility where it was determined he would need skin grafts. Genex's Nancy LeBlanc was assigned to the case and began coordinating the injured employee's care plan. To complicate matters, the man tested positive for COVID-19 during the height of the pandemic, delaying the procedure. Instead, he received temporary grafts and was transferred home with self-care guidance to quarantine. This necessitated critical coordination and communication from LeBlanc to ensure the claimant was able to change his dressings twice a day to avoid infection and manage his pain-medication pump to prevent overdose.
She also coordinated weekly physician visits through transportation services scheduled after provider business hours. One month post-injury, the injured employee tested negative for COVID and was immediately scheduled for permanent skin graft surgery, which LeBlanc coordinated. He was discharged home five days later, with outpatient protocol that included physical therapy three times a week at a local burn center. LeBlanc maintained contact with the injured employee regularly to answer questions and assure that all medical care was delivered in a timely manner. She also equipped the providers with the plant operator's job description so they could align therapy goals with his job functions. LeBlanc's efforts to secure timely vendor-approved care, home health, transportation services, therapy and DME, made a significant difference in redirecting a case headed for permanent disability to a full-duty success story. The man returned to work with restriction in less than five months, and full return to work less than three months later.
About Genex Services
Genex Services (www.genexservices.com) provides best-in-class clinical solutions that enable customers to transform their bottom lines while enhancing the lives of injured and disabled workers. Genex, a clinical management leader throughout North America, serves the top underwriters of workers' compensation, automobile, disability insurance, third-party administrators and a significant number of Fortune 500 employers. In addition, Genex clinical services are enhanced by intelligent systems and 360-degree data analysis. Its clinical expertise consistently drives superior results related to medical, wage loss, and productivity costs associated with claims in the workers' compensation, disability, automobile, and health care systems. Genex, Mitchell, and Coventry have recently combined their joint industry expertise and advanced technology solutions into one organization to simplify and optimize property, casualty, and disability claims processes and services.