Clinical Services for Workers Compensation Care Management

Take control of the claim and reduce costs with targeted interventions.

Injury Reporting

Your response to a workplace injury can set the trajectory for the claim. A coordinated response when the workers compensation claim occurs can minimize lost time and total claim cost. We take the first report of injury to the next level by integrating skilled intake specialists, credentialed medical provider listings and customizable escalation protocols for prompt medical attention and effective direction of care.

24/7 Nurse Triage

With our 24-hour Nurse First Response injury hotline, employees can speak to a nurse within minutes of an injury.  Staffed by registered nurses with clinical decision support technology at their fingertips, our triage service enables critical response at the point of injury. Employees receive care and treatment based on the severity of their injuries and unnecessary ER visits are reduced.

Nurse Case Management – Telephonic, Field, Catastrophic

Understanding the value nurses bring to managing workers’ compensation claims – and knowing what skills and qualities they need to succeed – can shorten claim duration and lower total claim costs. Our nurse case managers are excellent communicators, problem solvers and advocates. They know the healthcare system, and they are equipped with the unique skills needed to meet the challenges of workers’ compensation claims.

Let us connect you to more savings:

  • 5-10% reduction in medical costs per claim
  • 18% shorter claims duration
  • 8-12% reduction in average indemnity expense per claim

Specialty Case Management

Specially trained nurses use highly focused clinical intervention strategies to improve return to work and worker’s compensation claim resolution by managing chronic pharmacy claims, high cost surgery claims and long-term legacy claims.

Utilization Management

Whether applied prospectively, retrospectively or concurrently, utilization management engenders success stories. Cost savings are delivered, and quality of care and patient satisfaction are improved. Conduent’s Workers Compensation Utilization Management services are URAC-accredited and designed as a critical link between timely and appropriate treatment of injured employees and fair and cost-effective program results.

Integrated and standalone UM services are available to help you effectively manage workers compensation outcomes. All of our services can be customized according to state standards as well as client specifications.

We offer:

  • First Level Reviews by our utilization review nurses using state mandated and nationally recognized treatment guidelines, initiated through authorization requests.
  • Second Level Reviews, also called Clinical Peer Reviews (UM-CPR), when the requested medical treatment or service fails to meet treatment guidelines and a Physician Advisor is assigned to the case.
  • Medical Management Clinical Peer Reviews (MM-CPR) conducted by physicians and medical specialists, with the goal of achieving maximum medical improvement and return to work.
  • Drug Utilization Reviews to promote patient safety and control costs by targeting therapeutic appropriateness, over and underutilization, dosage, duration of treatment, duplication, drug allergies, and more.

UM decisions seamlessly integrate with Conduent’s medical bill review platform to maximize savings through prompt, accurate bill payment.

Pharmacy Management

Inappropriate and excessive medication is a hindrance to even the most aggressive return-to-work practices. To take aim at inflationary prescription costs and over-utilization, we’ve developed a pharmacy management solution that maximizes clinical engagement to decrease your pharmacy spend.  We combine drug utilization review, formulary management, and brand-to-generic conversions with comprehensive narcotics management, physician-dispensing discouragement, and drug compliance outreach to help you gain control over your pharmacy spend.

Drug Utilization Review

Since utilization, not only pricing, is a primary issue in escalating pharmaceutical costs, you need an aggressive action plan. Drug utilization review has emerged as an effective tool for promoting patient safety while controlling and containing medication costs.  This service analyzes the injured worker’s current drug regimen, including prescribing, dispensing and use of medications, to deliver a recommended treatment plan to transform outcomes.