SERVICES
MEDICAL CASE MANAGEMENT SERVICES:Case management services have been shown in recent surveys to provide a $30.00 savings for every $1.00 spent on disability lines to employers who utilize disability benefits for employees. Based on this finding and statistic, it is very important to realize the benefit of case management services. All Paragon consultants are trained in rehabilitation and are either certified masters level specialists or certified registered nurses. Case management services allow for continuity of care, on-going communication, and expeditious resolution of claims for employers.Case management services also allow for the identification of return-to-work options following an injury or illness in accordance with medically prescribed work restrictions. These services would incorporate job analyses, job descriptions, job modifications, etc. The benefit of on-going communication with all parties ensures a successful program outcome.
Onsite Medical Management:
Includes full medical management (injured employee, physician, employer contact) or flexible arrangements for specific requests.
Telephonic Case Management:
Includes file assignment to a specified Registered Nurse for complete medical case management services via telephone. This type of case management is a very cost-effective tool for claims that are not complex enough to require extensive onsite medical management.
VOCATIONAL SERVICES:Vocational/Re-employment Assessments identify an employee's current aptitudes, interests, and transferable skills when considering a return to his or her original job or to an alternative job, when assigned medical restrictions prevent a return to this position. An assessment of the injured or ill employee's transferable skills may make the difference between maintaining a valuable employee or having to lose this employee when job modifications are not feasible. Paragon has a variety of assessment tools with which to identify academic and vocational aptitudes, interests, skills, and job transferability. Vocational assessment includes aptitude testing, interest inventory, and vocational exploration with recommendations for further job development and/or placement.Paragon is proud to utilize OASYS software. Produced by Vertek, Inc. OASYS is a dynamic software program that provides objective and reliable information related to a job seeker's employability. The software also reports occupational outlook (current employment and projections,) and wage and salary data. OASYS allows access to useful information regarding career exploration such as: job descriptions, work requirements, wages and employment outlook. Transferable skills analyses are simplified with a skills and abilities profile for each individual; this can then be used to identify the closest matches for further potential employment. OASYS includes a tool to identify an individual's employment possibilities within a geographical labor market. Nationwide, statewide, or sub-state labor market data is supplied by the Bureau of Labor Statistics. This data also allows for the development of a profile to determine pre and post labor market access. (OASYS information obtained from vertekinc.com)
Labor Market Survey:
Conducted to determine viability of employment in a particular geographic
area. A vocational case manager will contact prospective
employers whose work environments match the client's vocational abilities
and physical restrictions
to determine job availability and salary levels. A report
with recommendations will be provided and the file will be closed unless
the carrier requests
further activity.
Transferrable Skills Analysis:
Conducted to determine injured employee's current skills for employment
while considering education, work history, physical abilities,
and interests.
Development and Implementation of Transitional Return-to-Work Programs:
Transitional return to work programs allow an employer to return injured
or ill employees to the original (or as close to the original)
position as possible on a graduated basis and in accordance
with the medical-physical work restrictions as determined
by the treating physician.
A job analysis
of the position is completed to identify the physical demands
of the job and transitional work duties. As the injured employee
continues to recover
from the injury, the physician allows the employee to gradually
increase the job duties until, ideally, the injured employee
is returned to the original
position. Transitional work is becoming more favorable for
employers as it allows the employee to remain involved
in his or her recovery while maintaining
working relationships and staying on the job.
Job Descriptions and Job Analyses:
Job descriptions review the components of positions to identify physical
demands of the jobs and essential and non-essential job functions,
qualifications to perform the jobs, and other miscellaneous
information important to the
employer to develop and maintain a qualified employee base.
This information is used to evaluate the performance of employees,
to identify reasonable
accommodations for transitional work duties or modified duties,
to hire of qualified personnel, etc. A job analysis is
a structured method of reviewing
the physical components of jobs by evaluating specific elements
such as lifting requirements; sitting, standing, walking,
pushing and pulling tolerances;
environmental factors and hazards and risks. Information
obtained from the job analysis is often used to complete
the job descriptions.
Ergonomic Evaluations:
With ergonomic considerations becoming more prevalent, employers will be
increasingly faced with providing work site ergonomic modifications
for employees to avoid or reduce the incidence of muscular
or skeletal disorders. Paragon has partnered with outstanding local providers
such
as Providian
to provide this needed service.
Vocational Placement Services:
A vocational case manager will meet one to two times per week with the injured
employee to provide appropriate viable job leads and will
assist in scheduling appointments and interviews. Follow
up with all leads will insure client
participation and compliance.
Job Placement Services:
Paragon has traditionally provided this service to employers who are not able to accommodate an injured or ill employee due to permanent medical restrictions. Job placement services are necessary when a return to the original position of a modified position is not appropriate with the original employer. Vocational assessment and job placement services may be provided to employers who may face corporate downsizing or a reduction in force for employees who may lose their jobs.
ADDITIONAL SERVICES:
Certified Life Care Plans:
A comprehensive plan forecasting the future financial costs of the medical
needs for a catastrophically injured person or a person with
a devastating illness. Such a plan extends throughout the life
expectancy of that individual.
Medical Legal File Reviews:
A report that details chronologically the medical treatment of the claimant. The nurse offers recommendations to the adjuster/claims examiner with regard to future treatment protocols and cost effective procedures currently available. This report includes a Medical Cost Projection upon request.
Medicare Set Asides:
A MSA report identifies the amount of settlement dollars to be set aside
for injury-related medical expenses typically covered by Medicare
in order to avoid the shifting of burden from the primary payer to Medicare.
Peer Review:
Paragon Case Management will arrange to have a specialized physician review medical records and diagnostic studies to determine appropriateness of care or proposed plan of treatment. A full report will follow the evaluation.
Independent Medical Evaluations (IME):
Paragon Case Management will coordinate and schedule an IME with appropriate
physician. We will send a letter to the physician confirming
the IME and listing requested information to be addressed by
the physician. A letter
will also be sent to the client to confirm the IME. The physician's
office will also be contacted for confirmation. With client
approval, we will attend the IME appointment to get the needed medical
information from the client
and physician. A report will then be generated providing the
requested information and the file will be closed unless the
insurance carrier requests further activity.
Medical and Bill Audits:
Review of a file and/or bill to render a nursing opinion on such issues as
appropriateness of treatment to claimant's diagnosis or accident
and subsequent related costs.
On-site Hospital Utilization Review:
Conducted to determine current medical status of patient and possible alternate care settings or services. Report on the appropriateness of ongoing hospitalization.
Custom Services/Task Assignments:
In addition to the standard services described here, Paragon Case Management will make every effort to accommodate individual needs through customized programs and services. We work with the carrier to define, design, and implement these custom services. We will also provide a Value Statement periodically to show your true cost containment savings, if necessary.
Medical Community Relationships:
Through our experience in this field, we have developed close working relationships
with many of the state's top physicians and treatment facilities.
We have negotiated rate reductions for many treatment facilities. We have
established
numerous vendor contacts for medical equipment and services.
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