Medical case management services

Pinnacol’s Medical Case Management (MCM) team ensures injured workers receive the right care at the right time to optimize health, well-being and functionality.

 

Claims with an assigned medical case manager had:

>15% Faster resolution

>18% Lower future medical costs

>25% Lower overall costs*

Medical case management team roles

Our MCM team consists of more than 30 medical professionals with over 300 years of collective workers’ compensation claims management experience.

 

Early intervention MCM: 

Becomes involved early in the claims process to recognize triggers that could cause delayed recovery.

Complex / delayed recovery MCM: 

Manages older, medically complex claims.

Utilization reviewers: 

Evaluates medical treatment requests from providers and provides timely decisions to authorize or deny the requests based on the Division of Workers’ Compensation Medical Treatment Guidelines.

Catastrophic MCM: 

Provides medical case management to injured workers who have experienced catastrophic injuries, such as brain or spinal cord injuries. Attends appointments and follows the claim until treatment has stabilized.

Field MCM: 

Provides offsite services, attends medical appointments with injured workers and helps coordinate treatment with multiple providers.

Discharge planners: 

Coordinates medical treatment for hospitalized, non-catastrophically injured workers to help with discharge needs and follow-up treatments. Ensures home health care services and equipment are provided in a timely manner.

Pharmaceutical manager: 

Oversees the opioid initiative program. Manages new opioid prescriptions, monitors dosing and usage to help prevent long term chronic use of opioids. Manages the utilization of high cost medications.

Therapy coordinators:

Assesses the medical necessity of physical therapy and other non-surgical treatments for low-back injury claims.

To find out more about our MCM services, contact us at 303.361.4000.

 

*Percentages based on a 2015 case study.