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Field-based case management provides a watchful eye on care and can help patients return to work.

Meet Jorge

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Jorge is a carpenter who fell while on a construction site. The doctor diagnosed him with a torn ACL requiring surgery and physical therapy. Per the adjuster on the case, Jorge was very compliant with everything the physician ordered, and appeared to be motivated to return to work. However, over time, he just wasn’t improving. Despite all his efforts, he continued to display laxity in his knee. His physician didn’t think he would improve any further.

Optum provides expertise

The adjuster decided to seek out advice from Optum. Brenda, a field nurse case manager, was assigned the case. Her medical background and clinical expertise was just what was needed to help get the case moving along. A plus, Brenda also lived close to Jorge.

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After Brenda reviewed the file and met with Jorge, she determined a second opinion of his knee was needed. The adjuster agreed and ordered another physician to evaluate Jorge. The new physician determined that the claimant’s knee was still loose, and he would require a second surgery.

Jorge-My-Story family image Optum’s URAC-accredited field-based case management services provide sound medical alternatives  that are effective, cost efficient and avoid unnecessary and inappropriate care. Delivered by registered nurses and vocational counselors, the program establishes claimant advocacy and channels injured patients to accessible network providers, where jurisdictionally appropriate. Treatment is managed proactively based on guidelines designed to promote recovery and eliminate costs and in accordance with jurisdictional regulations. With the Optum case management program, adjusters can closely manage the coordination of medical care and meet the full recovery and return-to-work objectives right from their desks.

Optum case management services

Optum case management services include:

  • Field-based case management
  • Telephonic case management
  • Vocational case management
  • Liability services
  • IME coordination
  • Medical cost projections
  • Life care planning
  • Pharmacy lifetime cost projections

Post surgery

Before the intervention and assistance of Optum and Brenda, Jorge had been out of work for over a year with very little progress, and it didn’t look like he would be going back anytime soon. However, the experience and insight that Optum brought to the case, helped switch it from a never-ending story to a happy ending.

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