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Risk Management Issues: Telephonic Case Management - Essay Example

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Risk Management issues: Telephonic Case Management Name Institution Risk Management Issues: Telephonic Case Management Introduction Telephonic case management is a sensitive issue which must be highly considered in every hospital setting. It is a proactive strategy which focuses on early intervention which is applied to manage any medical cases that may delay prompt and healthy return to work…
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Risk Management Issues: Telephonic Case Management
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Download file to see previous pages Significantly, telephonic case management is valuable in the provision of essential information on the severity of a given injury, and the complicated issues that may emerge. It also gives a detailed overview on the available opportunities for an early resumption of work. Broadly, it is concerned with the assessment of the injured worker’s medical needs, review, monitoring and evaluation of the available treatment choices, and the facilitation and harmonization of an effective communication among the employer, employees, and claims personnel to assist in a well-timed return to work (Fero et al., 2010). This service greatly impacts on the employers base lines through a reduction on the number of days the employees are off work due to the illness. In the provision of the telephonic case management services a highly qualified staff is required to bridge the gap between the employer and the injured employees. In the hospital facility the telephonic managers bring together the concerns of the hospital administration and any injured hospital staff for a quick treatment and cost settlements to achieve a timely return to work plan. Steps Taken to Address the Risk Management Issue Several steps have been discussed to address the issue of risk management in the hospitals. Remarkably, utilization management has greatly been considered in the push to attain a greater impact in the process of predictive modeling and data analysis. This step incorporates the effective evaluation of medical need, suitability and efficacy of the application of health care, processes and the facilities envisioned in the provision of an appropriate health benefits plan. Notable under this step is the hiring of highly qualified and experienced nurses who have been in the clinical practice for at least three years in the highly demanding and sensitive units in the hospitals such as the neurology, emergency room, radiology and the orthopedic units. There is also the employment of several board certified physicians who are important in the monitoring and evaluation of all the aspects of medical care while carrying out concurrent and retrospective reviews (Reilly et al., 2011). Case management is another step which has been employment by the hospital in its endeavor to solve the risk management issues. This has been provided to enhance a collaborative assessment process, the planning, facilitation of dialogue and timely settlement, the promotion of alternatives and services to meet a client’s health requirements via communication and existing resources to offer better quality, cost effective results. In view of these, a state of the art proprietary soft ware necessary for effective negotiation between the hospital managers and the ill workers has been installed to achieve a timely and cost effective communication. Through the electronic data interfaces (EDI), the hospital administration and the injured employees are able to download the case process, evaluate them and post their responses in time (Reilly et al., 2011). This facilitates a quick conclusion of the claims since the concerned parties can communicate immediately. Another notable step has been employed in the disease management process. Remarkably, disease management is the system of synchronized wellbeing interventions and dialogues for the hospital staff ...Download file to see next pagesRead More
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