In the dynamic realm of workers' compensation, immediate, knowledgeable clinical intervention early in the claim can change the trajectory of a claim outcome. Our directly employed telephonic case managers lead the charge by establishing trust at the earliest stages of a claim. When faced with the overwhelming challenges of an injury or illness, an affected individual can rely on our case managers to provide credible information, coordination of compassionate care, personalized support and education.
Our approach goes beyond basic care coordination, it's about ensuring clinically focused interventions play a pivotal role in resolving medical challenges, accelerating recovery, and facilitating a seamless return to work (RTW). While our telephonic support is available throughout the claim lifecycle, we've identified the first 90 days post-injury as a critical period for early intervention. It's during this window that our interventions have the most significant impact in resolving the claim before it lingers and becomes more complex.
The Comprehensive Benefits of Telephonic Case Management
- Advocacy Promotion: We champion the rights and needs of every injured or ill individual
- Employee Engagement: We actively engage injured/ill individuals in their recovery process, instilling a sense of ownership of their outcomes
- Cost Efficiency: Timely coordination of reasonable, necessary, and quality care reduces medical spend and improves claim outcomes
- Maximizing Potential: We not only focus on returning employees to work but help them reach their highest level of function
- Reduced Disability Durations: Our interventions are crafted to minimize the time an individual spends away from work, reducing disability durations
Whole Person Approach—The Heart of Our Strategy
We understand the importance of recognizing the unique circumstances, capabilities, and environments that impact one’s ability to recover from injury or illness. For recovery to be optimal, we must look beyond the primary injury or illness addressing the physical, mental, and social determinants of health that may impact recovery and return to work. Our case managers undergo specialized training in behavioral coaching and employ advanced coaching and education tools. This training helps them uncover any barriers that might hinder recovery and return to work.
Innovation in Data Integration, Risk Identification and Analytics
At Genex, we recognize it is imperative to innovate and leverage the latest technology to improve outcomes for our clients. Our life of the claim risk identification allows us to evaluate claims at the onset to identify those with claim attributes indicating a potential for becoming complex and assign a clinical resource for early intervention and resolution. As the claim matures, we are able to integrate data from medical, pharmacy and utilization review data to alert us on claims that are demonstrating risk due to emerging medical and pharmacy utilization patterns. This approach creates an opportunity to pinpoint claims needing a clinical resource and therefore ensuring better allocation of resources at the right time for the greatest impact.
Customized Program Design
Every client is unique. Our implementation team works closely with each client to creative a unique personalized program that integrates seamlessly with their claims process and yields the best possible outcomes. As the program matures, continuous analysis of outcomes allows for program adjustments based upon claim trends and cost drivers.