A passion for care. The power to help. Your Workers Compensation Specialists INSIDE: MEET THE TEAM The Collaborative Expertise That Counts
HOME HEALTH + COMPLEX CARE Kevin Glennon, RN, BSN, CDMS, CWCP, QRP Vice President of Clinical Education and Quality Assurance Programs Today, work comp claims are becoming increasingly complex with catastrophic injuries, obesity, older workers, and other conditions that cause complications. My unit helps clients coordinate care and manage the many moving parts of complex care cases. I have a background in case management, so I have first-hand experience that assists our customers in achieving best-possible outcomes while containing costs. I developed and manage our Home Health Quality Assurance program, which ensures our home care providers continually meet our standards of excellence. I also spend a lot of time educating claims examiners and nurse case managers. I also deliver CEUs to help them better understand and respond to complex cases and provide them with practical tips and takeaways they can apply in their work. Eric Patten, RN, BSN Director of Clinical Sales One Call has invested in an unparalleled level of clinical expertise to serve our customer s catastrophic and complex file needs. I once served as a catastrophic nurse case manager working on high-profile injuries, and this experience now allows me to provide effective peerto-peer support to adjusters and nurse case managers. I m available for on-site evaluations of high-exposure files to identify potential opportunities to convert into savings. Working with field case managers, we proactively evaluate and coordinate the needs of the injured workers prior to their discharge from the hospital to ensure a seamless transition of care. I also provide CEU training on many topics, including Clinical Management of Catastrophic Claims, Air Ambulance, and Diabetes adverse affect on claimant recovery.
Toby Ann Joyce, RN, CCM I help customers understand the value and benefits of our Complex Care team. This team consists of RNs and LPNs who can serve as care coordinators for their most catastrophic, complex, and high dollar files. Case managers enjoy interacting with our team because they can speak nurse to nurse with professionals who have a depth of clinical knowledge on the various types of services, equipment, and supplies these cases require. We handle everything from home health services, IV and wound care, durable medical equipment and supplies to air transport. We save customers significant costs, and we save their staff valuable time. I m also an adjunct resource available to clarify customer s clinical questions and provide their staff with enriching CEU training. Jonni Applefield, RN, BSN, MSN, FNP, CCM, CPDM I spend a lot of time in the field with our customers educating them about our Complex Care team. I help them understand the clinical value and coordination we can provide on complex files. With my varied experience as a nurse and field case manager, I understand how critical it is to get injured workers the care they need promptly and seamlessly, especially as they re discharged from the hospital. I also understand the pain points of busy adjusters and case managers; our goal is to make their lives easier. With our company, they can call on our complex care team and behind the scenes, we coordinate the plethora of services and equipment their complex cases require everything from transportation, durable medical equipment, and home care.
Hayley Tidwell, RN, BSN, CCM As a nurse, I previously worked on complex cases, so I understand the challenges these claims present to adjusters and nurse case managers; our Complex Care team is here to help. From the first indication that a claim is complex, our nurses can assist with coordination. When a claimant is about to be discharged, our team ensures the right in-home care and equipment is in place. For the life of the file, we proactively monitor the file and address issues that may arise. In this way, we optimize care for the injured worker, save costs for customers, and ease the burden of managing these files for claims staff. I also deliver CEUs on issues that impact claims complexity, including the aging workforce. Doris Hill, BSN Complex and catastrophic injuries are multi-faceted, often requiring home care, equipment, and other resources as injured workers transition from inpatient to home setting. We get involved as early as possible to ensure a smooth continuum of care and to control costs at every step. I serve as a facilitator in the event that adjusters or nurse case managers have questions or need further assistance. I help look ahead to what injured workers may need as they leave a hospital or rehab facility. My perspective is unique, as I ve worked for both provider and payer, and my nursing background ensures a clinical understanding of patient needs, so we can efficiently move referrals from the point of injury to claim s closure. I also assist in facilitating CEUs at our client sites.
Jeannette Sanger, RN, BSN, CRRN, LNCC Clinical Quality Improvement Coordinator Our complex and home care coordination teams provide services above and beyond what other companies offer. Prior to One Call, I worked at an insurance company, so I know what the customer wants as I was once in the customer s shoes. Now, as I oversee Quality Improvement and Wound Monitoring, I audit files to ensure our staff and nurses proactively work files to ensure timely delivery of appropriate, cost effective care to facilitate the best possible outcomes. As a Certified Legal Nurse Consultant, I also review files with an eye toward minimizing liability. For example, I make sure we alert customers of non-healing wounds like a severe pressure ulcer that can cost hundreds of thousands of dollars per hospitalization. We understand customers cannot monitor all the risks, so we serve as an extra set of eyes. Nancy Martz-Szabo, RN I serve as a clinical resource to One Call clients in the Midwest. With my prior experience in workers comp case management, I understand how challenging it is for nurse case managers. They often coordinate 25 to 30 cases and spend significant time in the field visiting injured workers. One Call strives to complement their case management efforts by coordinating the ancillary services. Nurse case managers, as well as claims adjusters, appreciate this assistance, as it helps them ensure a seamless continuum of care for injured workers, while also helping to contain costs on these complex claims.
Equipment + Devices Zack Craft, ATS, ATP, CRTS, CAPS, CEAC, NRRTS Vice President of Rehab Solutions and Complex Care Education One Call Equipment + Devices When customers have a catastrophic or complex injury case, my Rehab Solutions team assists in evaluating the medical equipment needs of the claimant, ensuring appropriate and functional equipment is recommended that fits the claimant s capabilities and lifestyle, while still being cost-effective for the payer. These equipment needs may include prosthetics, mobility solutions, assistive technology, home modifications, and other specialty equipment. Our team is unique to the industry. Each member is a credentialed Assistive Technology Professional (ATP), thus bringing extensive knowledge of equipment to bear on the file management and cost containment of these cases. I also play a significant role in educating adjusters and nurse case managers on equipment needs for complex care cases, including CEUs on Prosthetics and Mobility Solutions. Jordan Burch, COHC Audiology Sales Director One Call Equipment + Devices With my extensive background in working with audiologists and Ear, Nose and Throat doctors, my role helps to ensure quality and cost-containment for a customer s hearing loss claims. One Call s national audiology program delivers consistency in terms of providers, products, and pricing. Our credentialing process ensures claimants are seen by highly qualified audiologists and hearing specialists. Our team looks at every audiogram to ensure the evaluation was thorough and complete, and that the right hearing aid is being fit according to the claimant s lifestyle and level of hearing loss. We also spend a lot of time with customers, providing their claims examiners and nurse case managers with CEU training on the intricacies of hearing loss claims.
Jon Nau, COHC National Director of Audiology and Hearing One Call Equipment + Devices With the aging workforce, adjusters and nurse case managers are seeing more hearing loss claims and wondering how to best manage them. My extensive background in the hearing industry helps bridges this gap. Getting a claimant fit with a hearing aid can be a complex process. There is no fee schedule on hearing aids and there are thousands of products and providers to choose from. Payers find the range of options overwhelming, and cost containment is critical. We ve developed a turnkey hearing and audiology solution, which offers an extensive network of quality audiologists for accurate testing, and an Ear, Nose and Throat physician network to ensure the hearing loss is work-related. Our program provides cost containment, alleviates administrative burdens, and ensures the right providers and products are utilized. Dental + Doctor Laura Gorman, RN Vice President of Clinical Sales One Call Dental + Doctor Dental injuries occur with less frequency but present significant challenges, complications, and costs. Most dentists are accustomed to treating a patient s whole mouth, which can lead to overtreatment. We work on behalf of our customers to identify and utilize only qualified dentists, who perform a prospective oral evaluation and submit a dental treatment plan for approval. In this way, we ensure customers cover only the procedures related to the injury and that are required to restore functionality to the claimant s mouth. For complex dental injuries, which may require multiple specialists, we provide in-depth clinical expertise and care coordination, so claimants receive the best care possible. I ve also designed CEUs to help educate adjusters and nurse case managers about dental claims, procedures, and specialists.
easy ways to refer: HOME HEALTH + COMPLEX CARE P: 800.848.1989 F: 855.890.0224 complexcare@onecallcm.com homehealth@onecallcm.com EQUIPMENT + DEVICES P: 800.848.1989 F: 866.672.6807 equipment@onecallcm.com DENTAL + DOCTOR P: 888.539.0577 F: 888.539.0579 dental@onecallcm.com For multi-service referrals www.myeasyreferral.com Avoid Last-Minute Delays. Identify injured workers two weeks prior to hospital discharge or an upcoming surgery and One Call will line up the appropriate equipment and services all before the injured worker leaves the facility. For a stress-free discharge home: P: 800.848.1989 ext. 4196 complexcare@onecallcm.com Copyright 2015 One Call Care Management. All rights reserved