Facilitating Claims Establishing capacity level FOR INTERNAL USE ONLY

Slides:



Advertisements
Similar presentations
Project for Early Support of Elderly People in their Daily Lives (VAMU) Centre for Social and Health Services, City of Kuopio,Finland Anne Tuovinen, MHS,
Advertisements

Unit 1 – Sports Medicine Overview Standard 1: Students will explore the fundamental aspects of Exercise Science/Sports Medicine. What is Sports Medicine?
Stress in Nurses Starting Work Andy Smith. Healthy Minds at Work: An ESF funded project.
Return to Work Program Through the Utilization of Medical Management and Vocational Rehabilitation Services Sylvia Rolison, BSN, MPH, CCM Pete Mills, M.Ed.,
(personalize with your name) Transition Counselor Division of Rehabilitative Services (Date)
Mental Health claims: JEIS and LTD Approach Public Education Benefits Trust Conference November 26, 2013.
Considering Assistive Technology and the AT Plan Sara Menzel, ATP UCP Michigan Assistive Technology Center
Family Centered Approach Hussain Ali Maseeh, Psy.D. Director of SEDIC.
1 MARSHALL SPACE FLIGHT CENTER POLICY GUIDANCE ON EXECUTIVE ORDER ESTABLISHING PROCEDURES TO FACILITATE THE PROVISION OF REASONABLE ACCOMODATION.
Islamic University of Gaza Faculty of Nursing
Introduction of child assessment  一、 What is child assessment ( or evaluation )?  二、 Purposes or goals of child assessment  Educational and clinical.
About RESNA: RESNA, the Rehabilitation Engineering & Assistive Technology Society of North America, is the premier professional organization dedicated.
Critical Thinking in Nursing. Definition  Critical thinking is an active, organized, cognitive process used to carefully examine one’s thinking and the.
Workers Compensation Managed Care By: Laura Deterding, ACAS, MAAA Midwest Employers Casualty Company.
1 Nurse Intervention. 2 Purpose Nurses play a vital role in case management by participating in the early, medical management of cases. The primary focus.
Workplace Disability Management (Name of Presenter) (Date)
Clinical Outpatient Practice Sites MCV Campus Specialty: TBI, SCI, musculoskeletal HEALTHSOUTH Medical Center Specialty: Chronic Pain, musculoskeletal,
CASE MANAGEMENT OVERVIEW l Introductions l Definitions l Objectives l Rehabilitation Counselor –Role –Case Management l Models –Public –Private –Interdisciplinary.
Case Management Teams Marianne Cloeren, MD, MPH USACHPPM Force Health Protection.
Sick Leave and Disability Management Program Human Resources | March 2012.
JOB COACHING Nicole Picariello Nicole Ploussas Nicole Honrath Adina Faulkner.
© 2007 McGraw-Hill Higher Education. All rights reserved. 1 School Health Services: Promoting and Protecting Student Health Chapter 2.
Diversified Occupations Presented by Mrs. Fisher, BHS Coordinator.
(A Holistic Approach to Dealing With the Injured Employee) Presented by: Robin Merriweather Commander, Navy Region Southwest San Diego August 2003 Medical.
Occupational health nursing
Verification: Quality Assurance in Assessment Verification is the main quality assurance process associated with assessment systems and practice - whether.
The Athletic Health Care Team
Occupational Medicine Recognized Specialty Since 1949 Combines Clinical Skills With Toxicology, Epidemiology, Safety, Rehabilitation, and Business Operations.
Sue Keener Director of Virginia Office of Workers’ Compensation GOVERNOR'S HEALTH POLICY ADVISORS ANNUAL CONFERENCE.
TRACKING THE ELUSIVE FUNCTIONAL LIMITATION: HOW TO RECOGNIZE THE 7 MOST IMPORTANT SPECIES IN THE WILD! Youth Transition Program Statewide Conference February.
Vigdís Jónsdóttir, Managing Director Vocational Rehabilitation Fund Motivation – Participation - Opportunities The Emphasis of Vocational Rehabilitation.
Occupational Health. Occupational Medicine Recognized Specialty Since 1949 Combines Clinical Skills With Toxicology, Epidemiology, Safety, Rehabilitation,
The Athletic Health Care Team
Unit 1 – Sports Medicine Overview Standard 1: Students will explore the fundamental aspects of Exercise Science/Sports Medicine. What is Sports Medicine?
Nurse Intervention. Purpose Nurses play a vital role in case management by participating in the early, medical management of cases. The primary focus.
1 Stakeholder Consultation U.S. Department of Labor (DOL) Office of Workers’ Compensation Programs Division of Federal Employees’ Compensation Strategic.
A Gift of Fire, 2edChapter 10: Professional Ethics and Responsibilities1 Professional Ethics and Responsibilities.
504 PLANS FOR STUDENTS WITH DISABILITIES Accommodations are applicable in the areas of : Curriculum, Day-to-day-day classroom assignments Student assessments.
Stress in a University George Mark. University employees can face high levels of stress & negative mental health. These may often relate to workplace.
© 2007 Thomson - Wadsworth Role of the Dietitian in the Health Care System Chapter 2.
Transition: Indicator 13 Professional Development August 2009.
Metka Teržan, MD, specialist of occupational medicine
BBSST: Building Based Student Support Team Blount County Schools James E. Carr Superintendent.
Allied health professionals make up 60 percent of the total health workforce. They work in health care teams to make the healthcare system function by.
Nuts and BoIts of Returning Employees to Work Shelley Stoyles BSc. OT And Todd Lewin BSc. PT Eastern Rehabilitation Inc.
DELEGATION DELEGATION Doing It Right Our Objectives To delegate patient care task safely & appropriately To understand laws & regulations affecting.
OCCUPATIONAL THERAPISTS AND THE WORKPLACE Laura Hicks B.App.Sc. (OT)
Chapter #06 Vocational training, apprenticeship, and skills development of Employees.
Supported Employment Session 2: Supporting the customers of supported employment.
MRoA/MMRC Munich Re Group Life Seminar 2008 The value of the occupational therapist Yolanda Skei 21 February 2008.
“All kids get to go to school and get a fair chance to learn. That’s the idea behind IDEA. Getting a fair chance to learn, for kids with disabilities,
AN EXAMPLE OF WORK-BASED TRAINING AND SUPPORTED EMPLOYMENT OF A PERSON WITH VISUAL IMPAIRMENT IN PUBLIC SECTOR TEJA BANDEL CASTRO, Msc, psychologist Ljubljana,
WORK DISABILITY EVALUATION IN SLOVENIA EVA KOSTA, MSc, MD The Institute of Pension and Disability Insurance of Slovenia Board of Medical Assessors.
INTRODUCTION This is an overview of MRC Who the program is for
ACT Comprehensive Assessment
5 STEP IMMEDIATE INTERVENTION RTW MODEL
SAFE 101 NSC Chapter 12.
Fundamentals of a Vocational Assessment
Understanding the Section 504 Process
THE NURSING PROCESS A systematic problem-solving approach used to identify, prevent and treat actual or potential health problems and promote wellness.
NHN member organizations
Unit 1 – Sports Medicine Overview
Understanding the Section 504 Process
What helps the work partnership. : 1
Return to work assessment services 29 May 2014 Leanne Ho Manager, Allied Health and Return to Work Services.
Unit 1 – Sports Medicine Overview
The Athletic Health Care Team
Occupational Health Working together.
Intensive Intervention – Tier 3
National Hospice and Palliative Care Organization’s Palliative Care Resource Series Understanding the Importance of the Interdisciplinary Team in Pediatric.
Presentation transcript:

Facilitating Claims Establishing capacity level FOR INTERNAL USE ONLY REAL Disability Story 082310 Facilitating Claims Establishing capacity level Disability Claim Manager Nurse and Physician Team Lead and Technical Specialist Rehabilitation Specialist Taking a Holistic View Understand client’s plan design Understand employment and personal circumstances Assessing Claims Analyze medical aspects Evaluate physical and functional capacity Validating Decisions Understand contractual provisions Apply provisions to specific situations Defining Employability Assess physical and cognitive demands Assess future employability The goal of the Facilitated Claim Discussion is to establish a claimant’s capacity level. These discussions leverage the expertise of the Disability Claim Manager, a nurse and/or a physician, a Team Lead or technical specialist, and a vocational rehabilitation specialist. Each professional has a special role. Disability Claim Managers have overall responsibility for management of the claim. They ensure that all necessary information is obtained, and maintain a dialog with the employee. Their assessment of the employee adds a holistic view to the discussion. They have knowledge of the plan design—and they know the employee’s employment and personal circumstances. The clinical assessment is provided by members of our Clinical Team. The goal of our clinical review is to evaluate the medical data, verify and clarify the diagnosis, identify the appropriate duration, and determine the need for additional medical documentation. Lastly, it’s to establish future interventions based on the medical situation. Critical to every discussion is a contractual assessment, which validates the claim decision. The Team Lead or Technical Specialist is well versed in the contractual provisions—and on how to appropriately apply those provisions to specific claim circumstances. As we mentioned earlier, the Vocational Rehabilitation Specialist has a dual role. First to assess the claim situation from a vocational standpoint at the “any occupation” review point—what are the physical and cognitive demands of the occupation? Then, from a rehabilitation standpoint—what is the employee’s specific future employability situation? Are they a candidate for Prudential’s rehabilitation program? Are workplace accommodations needed? Or, are other return to work services more appropriate, like job placement or job training? Let’s take a look at capacity levels now… FOR INTERNAL USE ONLY

Facilitating Claims Establishing capacity level FOR INTERNAL USE ONLY REAL Disability Story 082310 Facilitating Claims Establishing capacity level Disability Claim Manager Nurse and Physician Team Lead and Technical Specialist Rehabilitation Specialist The goal of the Facilitated Claim Discussion is to establish a claimant’s capacity level. These discussions leverage the expertise of the Disability Claim Manager, a nurse and/or a physician, a Team Lead or technical specialist, and a vocational rehabilitation specialist. Each professional has a special role. Disability Claim Managers have overall responsibility for management of the claim. They ensure that all necessary information is obtained, and maintain a dialog with the employee. Their assessment of the employee adds a holistic view to the discussion. They have knowledge of the plan design—and they know the employee’s employment and personal circumstances. The clinical assessment is provided by members of our Clinical Team. The goal of our clinical review is to evaluate the medical data, verify and clarify the diagnosis, identify the appropriate duration, and determine the need for additional medical documentation. Lastly, it’s to establish future interventions based on the medical situation. Critical to every discussion is a contractual assessment, which validates the claim decision. The Team Lead or Technical Specialist is well versed in the contractual provisions—and on how to appropriately apply those provisions to specific claim circumstances. As we mentioned earlier, the Vocational Rehabilitation Specialist has a dual role. First to assess the claim situation from a vocational standpoint at the “any occupation” review point—what are the physical and cognitive demands of the occupation? Then, from a rehabilitation standpoint—what is the employee’s specific future employability situation? Are they a candidate for Prudential’s rehabilitation program? Are workplace accommodations needed? Or, are other return to work services more appropriate, like job placement or job training? Let’s take a look at capacity levels now… FOR INTERNAL USE ONLY

Facilitating Claims Establishing capacity level FOR INTERNAL USE ONLY REAL Disability Story 082310 Facilitating Claims Establishing capacity level Disability Claim Manager Nurse and Physician Team Lead and Technical Specialist Rehabilitation Specialist Taking a Holistic View Assessing Claims Validating Decisions Defining Employability The goal of the Facilitated Claim Discussion is to establish a claimant’s capacity level. These discussions leverage the expertise of the Disability Claim Manager, a nurse and/or a physician, a Team Lead or technical specialist, and a vocational rehabilitation specialist. Each professional has a special role. Disability Claim Managers have overall responsibility for management of the claim. They ensure that all necessary information is obtained, and maintain a dialog with the employee. Their assessment of the employee adds a holistic view to the discussion. They have knowledge of the plan design—and they know the employee’s employment and personal circumstances. The clinical assessment is provided by members of our Clinical Team. The goal of our clinical review is to evaluate the medical data, verify and clarify the diagnosis, identify the appropriate duration, and determine the need for additional medical documentation. Lastly, it’s to establish future interventions based on the medical situation. Critical to every discussion is a contractual assessment, which validates the claim decision. The Team Lead or Technical Specialist is well versed in the contractual provisions—and on how to appropriately apply those provisions to specific claim circumstances. As we mentioned earlier, the Vocational Rehabilitation Specialist has a dual role. First to assess the claim situation from a vocational standpoint at the “any occupation” review point—what are the physical and cognitive demands of the occupation? Then, from a rehabilitation standpoint—what is the employee’s specific future employability situation? Are they a candidate for Prudential’s rehabilitation program? Are workplace accommodations needed? Or, are other return to work services more appropriate, like job placement or job training? Let’s take a look at capacity levels now… FOR INTERNAL USE ONLY

Facilitating Claims Establishing capacity level FOR INTERNAL USE ONLY REAL Disability Story 082310 Facilitating Claims Establishing capacity level Disability Claim Manager Nurse and Physician Team Lead and Technical Specialist Rehabilitation Specialist Taking a Holistic View Understand client’s plan design Understand employment and personal circumstances Assessing Claims Validating Decisions Defining Employability The goal of the Facilitated Claim Discussion is to establish a claimant’s capacity level. These discussions leverage the expertise of the Disability Claim Manager, a nurse and/or a physician, a Team Lead or technical specialist, and a vocational rehabilitation specialist. Each professional has a special role. Disability Claim Managers have overall responsibility for management of the claim. They ensure that all necessary information is obtained, and maintain a dialog with the employee. Their assessment of the employee adds a holistic view to the discussion. They have knowledge of the plan design—and they know the employee’s employment and personal circumstances. The clinical assessment is provided by members of our Clinical Team. The goal of our clinical review is to evaluate the medical data, verify and clarify the diagnosis, identify the appropriate duration, and determine the need for additional medical documentation. Lastly, it’s to establish future interventions based on the medical situation. Critical to every discussion is a contractual assessment, which validates the claim decision. The Team Lead or Technical Specialist is well versed in the contractual provisions—and on how to appropriately apply those provisions to specific claim circumstances. As we mentioned earlier, the Vocational Rehabilitation Specialist has a dual role. First to assess the claim situation from a vocational standpoint at the “any occupation” review point—what are the physical and cognitive demands of the occupation? Then, from a rehabilitation standpoint—what is the employee’s specific future employability situation? Are they a candidate for Prudential’s rehabilitation program? Are workplace accommodations needed? Or, are other return to work services more appropriate, like job placement or job training? Let’s take a look at capacity levels now… FOR INTERNAL USE ONLY

Facilitating Claims Establishing capacity level FOR INTERNAL USE ONLY REAL Disability Story 082310 Facilitating Claims Establishing capacity level Disability Claim Manager Nurse and Physician Team Lead and Technical Specialist Rehabilitation Specialist Taking a Holistic View Understand client’s plan design Understand employment and personal circumstances Assessing Claims Analyze medical aspects Evaluate physical and functional capacity Validating Decisions Defining Employability The goal of the Facilitated Claim Discussion is to establish a claimant’s capacity level. These discussions leverage the expertise of the Disability Claim Manager, a nurse and/or a physician, a Team Lead or technical specialist, and a vocational rehabilitation specialist. Each professional has a special role. Disability Claim Managers have overall responsibility for management of the claim. They ensure that all necessary information is obtained, and maintain a dialog with the employee. Their assessment of the employee adds a holistic view to the discussion. They have knowledge of the plan design—and they know the employee’s employment and personal circumstances. The clinical assessment is provided by members of our Clinical Team. The goal of our clinical review is to evaluate the medical data, verify and clarify the diagnosis, identify the appropriate duration, and determine the need for additional medical documentation. Lastly, it’s to establish future interventions based on the medical situation. Critical to every discussion is a contractual assessment, which validates the claim decision. The Team Lead or Technical Specialist is well versed in the contractual provisions—and on how to appropriately apply those provisions to specific claim circumstances. As we mentioned earlier, the Vocational Rehabilitation Specialist has a dual role. First to assess the claim situation from a vocational standpoint at the “any occupation” review point—what are the physical and cognitive demands of the occupation? Then, from a rehabilitation standpoint—what is the employee’s specific future employability situation? Are they a candidate for Prudential’s rehabilitation program? Are workplace accommodations needed? Or, are other return to work services more appropriate, like job placement or job training? Let’s take a look at capacity levels now… FOR INTERNAL USE ONLY