WAYNE, Pa.--(BUSINESS WIRE)--Three case managers were selected from more than a thousand highly skilled professionals to be named 2018 Heart of Case Management Award winners. This is the third year of the national awards program spotlighting case managers at Genex Services, one of the nation’s largest providers of managed care services to the workers’ compensation, disability, and automobile insurance markets.
Genex’s case managers are highly regarded in the industry for transcending beyond their traditional job duties to improve the lives of thousands of injured employees each year. Case managers were nominated by their Genex managers across the country and judged on the following criteria: specialist, excellence, adaptability, trust, influential communication and outcomes. Judges selected three winners whose efforts in highly involved cases made a significant impact on their claimants. Click here to watch a video and hear our winners share their experiences of case management at its best.
The following are synopses of the winning entries.
Field Case Management
Theresa Martin, RN, BSN, CCM, Schaumburg, IL
Out-of-the-box thinking is sometimes necessary for ensuring the best care and recovery for an injured employee. For Martin, those critical thinking skills were put to the test in a case involving a 53-year-old male who sustained serious lower extremity injuries after a stack of pallets fell on him, resulting in shinbone fractures on both legs. The man was rushed to the emergency room where it was determined he would need immediate surgery and reconstruction which was performed the same day. However, since he was injured in a different state from where he lived, he would have to rehab locally rather than near his home in Indiana. Realizing the injured employee would benefit from having his family nearby, Martin quickly coordinated his transfer to an acute rehab facility that would accept an out-of-state jurisdiction claim and the associated rates of reimbursement. When it came time to transfer the employee home, Martin arranged for home modifications, durable medical equipment, and transportation to local outpatient rehab facilities to assure the injured employee stayed on track with his goals. This negated costly home health medical care and home-based therapy, while allowing the claimant to pursue more aggressive therapy at the rehab center. Martin worked with the medical provider, therapists and employer to coordinate a return to modified duty five months after the injury and full duty with no restrictions within a year.
Catastrophic Case Management
Carrie McCullin, RN, CCM, Metairie, LA
Catastrophic case managers need to prepare for crisis no matter the day or hour. Such was the case when McCullin fielded a call one Saturday morning. An officer was in critical condition from multiple gunshot wounds, including one to the head, incurred in the line of duty. The initial treatment involved stabilizing the officer who had sustained a subdural hematoma and fractured jaw. McCullin served as an intermediary between providers, the injured officer and his family, offering assistance and reassurance. After undergoing a successful craniectomy, evacuation of subdural hematoma and reduction of jaw fracture, the officer faced the reality of a long recovery. A practicing RN for 27 years, McCullin understood the process of transitioning the injured officer from ICU to a specialized brain injury facility to home. The officer used a cranial helmet to protect the non-flapped craniectomy site and through McCullin’s diligence, ensured he didn’t incur an infection which helped expediate his move to a traumatic brain injury specialty hospital. McCullin assisted the officer and his family throughout the transition and worked with physical, occupational and speech therapy to help him regain his activity of daily living skills, while keeping ODG in perspective for his return-to-work status. The officer surpassed his prognosis, returning to duty in just 8 months, 4 months prior to the initial assessment.
Telephonic Case Management
Dana Schwartz, RN, CCM, Albuquerque, NM
One of the unique advantages a case manager brings to a workers’ comp case is a wholistic approach to treatment. This was evident when telephonic case manager Schwartz was assigned a case involving an injured construction worker who was recovering from a fractured leg. The employee not only struggled overcoming his physical injury but also sobriety, which impacted his use of pain-management medications. Schwartz developed a positive relationship with the injured person, gaining his trust and guiding him through the workers’ comp and post-op rehab process. The construction worker was able to ween off narcotics and only need acetaminophen for pain management, which allowed him to focus on post-op rehab and return to work. Schwartz’s long-standing relationship with the employer allowed her to understand their policies on modified duty and return to work. Her skill in working closely with providers helped her keep treatments on track and obtain an early release that would return the injured worker back to his job ahead of schedule. This case reflects the importance of how case management compassion often leads to positive outcomes.
More in-depth information on each case management story can be found at www.genexservices.com/fromtheheart
About Genex Services, LLC
Genex Services (www.genexservices.com) is the trusted provider of managed care services enabling clients to transform their bottom lines while enhancing the lives of injured and disabled workers. Genex is a managed care leader with more than 2,900 employees and 41 service locations throughout North America. The company serves the top underwriters of workers’ compensation, automobile, disability insurance, third-party administrators and a significant number of Fortune 500 employers. In addition, Genex is the only company that delivers high-quality clinical services enhanced by intelligent systems and 360-degree data analysis. The company 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.