Nurse Case Management
“Getting the most out of your healthcare investment.”
Frequently individuals faced with illness and hospitalization are frightened and anxious, and they don’t always understand everything the treating provider has to say — or know what questions to ask. Our nurse case managers are perfectly suited by education and temperament to ensure good communication amongst all relevant parties.
Identifying the need…
Group Health programs generally don’t have adjusters like other insurance programs. They most often have claims processors, which for the most part, have no one to ensure the care a patient receives is timely, effective, and coordinated with all treating providers. Most cases move forward with no coordination, resulting in them taking on a life of their own, wasting a lot of precious time and money.
The Role of a Nurse Case Manager
The ultimate goal of the nurse case manager is to assist the patient in returning to optimal health as soon as possible. This is why their role can be so important in reducing costs associated with hospital stays, surgeries, and a number of chronic illnesses. They ensure specialty referrals are made promptly, that the patient understands the treating provider’s instructions, and orders for prescription drugs are followed correctly to enhance recovery times — and that saves money for everyone!
How we can help!
MediReview has a professionally trained team of registered nurses who are Certified Case Managers. Collectively, MediReview has managed thousands of cases over the past 30 years of service. There are numerous tools used by our nurse case managers, perhaps the most valuable, is their knowledge of the healthcare system, what questions to ask, and how to move someone through it quickly and effectively!
A few tools we have in our belt…
These are a few tools our nurse case managers may be able to utilize when providing excellent service to healthcare case needs
Centers of excellence
Nothing saves money like great care, and great care often comes from facilities that have devoted extra effort to understanding and treating a particular disease process. It is MediReview’s job to help identify those Centers of Excellence, and when possible, ensure that your patient is treated where outcomes are the best.
Proactive management of diseases reduces complications and saves money for all concerned. MediReview has specific programs that can help better manage chronic diseases such as diabetes and congestive heart disease.
patient accountability and compliance
Compliance with pharmaceutical treatment plans, communication amongst a variety of treating providers, and appropriate specialty referrals help you get the most out of your healthcare investment by holding the patient and treating provider accountable.
Customized pre-certification approval criteria may be implemented for expensive and/or specialty medications.
Single Case Agreements
MediReview case coordinators are uniquely trained to identify out-of-network providers/facilities and negotiate Singe Case Agreements to reduce charges to reasonable levels based on reference-based pricing.
Our experienced intake specialists are available to assist patients in navigating the complexities of the healthcare system and identifying appropriate providers/facilities for care.