Medical Case Management
The goal of an Employee Health Plan is to provide quality care for all Participants, but there are some cases that need more intensive intervention.
CMRG's Case Management Program identifies those cases requiring more attention, providing improved medical outcomes for our patients as well as cost containment and savings for our Plan Sponsors. CMRG's program is specifically designed to identify catastrophic illness and injury cases. It is also designed so that our review nurses are prompted to ask questions about seemingly uncomplicated cases that may reveal indications of increased risk. Once a high-risk case is identified, CMRG provides the level of case management services required by the intensity of the case in the most cost-effective manner possible.
The key to success is our case managers’ ability to identify, coordinate and negotiate alternative treatment plans and costs. Our nurses work to insure that the patient’s care is taking place in the most appropriate setting, whether it is the patient’s home, a skilled nursing facility or an outpatient facility. The nurses interact with the patient, the family, providers and facilities, as well as additional ancillary vendors such as home health providers and local support groups, to develop an appropriate treatment plan that utilizes the patient’s benefits plan and claim dollars as efficiently as possible.