Case Management

In the absence of clinical guidance, a workers’ compensation claim can quickly escalate from a simple injury to a high-cost, complex maze of medical treatment and indemnity payments.

We are skilled at addressing medical treatment plans to ensure expedient, quality care and aid in the global claims management process. We don’t believe every claim warrants a nurse case manager. By reserving clinical resources for claims which warrant specific oversight and management, our nurses assist on claims with multiple body parts, complex diagnoses, costly treatments or injuries to specific body parts which have proven costly.

By proactively addressing comorbidities, return to work, recovery barriers, new symptoms, treatment outside of guidelines, claims with newly prescribed opioids and claims with excessive pharmacy utilization, our experienced Registered Nurses provide evidence-based clinical guidance to promote comprehensive, aggressive claims management.

 

             
          

          

 Fact Sheet 

    

          

Coverage Map

    

          

 Submit a Referral

           

 

FEATURES

  • URAC accredited in Case Management
  • Telephonic case management for claims requiring ongoing management either upon first report of injury or as medical treatment escalates outside of anticipated guidelines
  • Field case management for claims requiring face-to-face interaction
  • Strategic clinical programs targeted toward specific interventions, including emphasis on:
    • pharmacy utilization management
    • pharmacy utilization intervention
    • discharge planning
    • catastrophic case management
  • Identification of claims warranting clinical oversight from back-end data analytics
  • 24/7 access via secure web platform

 

 CLIENT TESTIMONIALS

I just wanted to take time to formally thank you for your remarkable service! From the very first meeting with you at my home to the very last appointment with the doctor you have been exceptional. You have been kind and compassionate and really made me feel certain that I would get better. You have gone out of your way to help me understand the whole process and have guided my steps. I wish you only the best of things to come. I do hope that your company truly appreciates the gem that you are!
-Injured Worker

"My nurse case manager is the best. My medical needs were addressed for a speedy recovery. I am blessed to have the best nurse case manager!"
-Injured Worker

"It has been a delight working with all of you this past year and I am looking forward to an equally successful upcoming year."
-Occupational Health Manager, an International Hotel

"I absolutely love working with the nurses of EK Health. I'm new to the adjusting world, and they treat me with kindness and respect despite my innocent queries. I ask them to 'talk to me like I'm 3,' but they are never condescending. I don't have to ask for status updates because I receive them before I need them; on-time, easy-to-read, succinct. And if my 'hair's on fire' with an urgent request, they're there to put out the emergency flames with a same-day response; quite often within the hour!!! "The EK Health team is one I hope to be working with for a long time to come."
-Claims Examiner, a National TPA

"I want to tell you how much I enjoy working with your staff. They are right on top of things. Your nurses all go above and beyond the call of duty. I know that our Claims Manager was displeased with our designated provider and after consulting with me reassigned one of our files to one of your nurses. After reading the file, the nurse picked up on the fact that the man had an aneurysm and subsequently had his physical therapy stopped. Thank your staff for a job well done! I look forward to working with you."
-RN, Nurse Consultant, a National Insurance Company

"As you know, we have enjoyed a long and successful working relationship with EK Health for many years, and our account manager in particular has always been very proactive and responsive to our needs. We are extremely pleased with the caliber of nurses you employ, and having bilingual capability with several languages definitely sets you apart. When we need to utilize a field case nurse, EK Health is definitely our first call. Thanks for the great service!"
-RN, Senior Nurse Manager, a National TPA

"I continue to be exceptionally pleased with EK nurses."
-Senior Claims Adjuster, a National TPA

"I can count on my EK account manager if I have any difficulties. We are all pleased to be working with EK Health."
-Claims Manager, a National Insurance Company

"Your nurse has done an excellent job for me on a case with a difficult doctor. Please pass on my highest compliments."
-Claims Examiner, a Major TPA

"I am very pleased with all that EK Health is doing for me. Good communication from your nurses -- they are having a real impact on my cases."
-Claims Examiner, a National Insurance Carrier

"The quality of nursing at EK Health is excellent. Their easy online referral system makes my job simpler."
-RN, a National Insurance Company

"EK is a partner that provides input, guidance, and recommendations."
-Senior Claims Examiner, a National Insurance Company

"We have been very pleased with all of the referrals we have sent over to your company. Your nurse in Modesto has been exceptional in his work and great at getting cases to the right doctors in the area."
-Nurse Manager, a National Insurance Company

"The case manager assigned to our cases is awesome. I couldn't ask for better. Her reports are on time and comprehensive. Her communication is not only excellent with me, but also with the injured workers and doctors. I feel like she and I work together as a team, and that the injured workers benefit greatly."
-Claims Examiner, a Regional TPA

"EK Health Services' NCM is assigned to the claim with a man who had a 2/17/09 single foot amputation with other factors such as accepted diabetes, obesity, and psyche. Due to the complexity of his needs, and concerns over coordination, it was decided to hire a NCM. I am very pleased with the job that your NCM is doing. He keeps me informed. He did a home visit and went to the doctor appointment. He is looking at the BIG PICTURE (which is what we wanted). He is looking into all the medications that the EE is receiving as well as reviewing his home modifications. He is proactive in dealing with the other treaters on the claim. He has even won over the applicant attorney who had been adamant about hiring their own NCM."
-Claims Adjuster, a Large Insurer in California

"The nurse case manager I was involved with is a very detail-minded and caring person, exactly what we need for a great nurse case manager."
-Chinese Interpreter

"I wanted to bring to your attention what a great job your nurse case manager is doing for our client. We had our semi-annual claim review yesterday. The brokers were here and were complimentary of your nurse case managers' results on the program. Specifically it was brought up that she achieved 4 return to work cases in one day! It is a pleasure to have a nurse case manager that can be relied upon to get the job done. Your nurse case manager meshes well with our team and is a true asset."
-Claims Supervisor, a Third Party Administrator

"Your NCM did one heck of a job for us and she is to be commended for her quick response and getting control of a difficult situation. I’ll let her fill you in on the details, but I did want to pass along my compliments on your NCM's outstanding service on this case. It is most appreciated!"
-Claims Supervisor, a National TPA

"I think the services provided by EK Health are the best. They make a client feel like they are the only client they have. I know they have a vast number of clients, but they make me feel like I am the only one. EK Health's nurse case managers are the best and I had a few before and they really are the best. They do a lot for me and I could not get along without them. I would not want anybody else. EK Health's administrative staff in the office are very polite. They take care of me and take care of my needs very fast. They get me connected to the nurse case manager right away especially if I need to talk with the nurse urgently. They are very efficient people in the office and I really like that."
-Injured Worker

“I am writing to let you know what a great representative your nurse case manager has been for your company. Your nurse case manager has been present at all of my physician appointments and has been just great at explaining the confusing world of medicine and insurance to me. She made all of it much easier to understand. Based on her experience, she was very helpful with anticipating my possible needs both before and following surgery. She was always available to discuss my therapies and procedures that might aid and assist with my speediest recovery and return to work. As my nurse case, she has been so kind, and also very professional about the directions and goals of my necessary medical care. I wanted to let you know how much I have appreciated her services."
-Injured Worker

"I utilize EK Health for Nurse Case Management and Ergonomic Services and their nurses and ergonomic consultants are responsive and great to work with! I cannot ask for more. They go above and beyond what my expectations are. EK Health is the company that comes to my mind first when I need a nurse case manager or ergonomic consultant."
-Risk Manager, a Fortune 500 Company

"EK Health's nurse case manager is doing an excellent job for us and we appreciate it greatly. I know EK Health's nurse case manager works very hard for us and does not always encounter the most receptive medical providers. The nurse case manager "plugs away", however, and we appreciate the nurse case manager's dedication."
-Personnel Analyst, a Municipality

“I just wanted to let you know that your in-house nurse is so wonderful to work with. I have a case that got really ugly, really fast. My injured worker has had 5 surgeries on his elbow and had developed a staph infection of the bone. He had surgery to clean out the infection and remove some of the bone. He has been well, but suddenly, the infection came back. He is going back in for a 6th surgery to remove additional bone and try and get the infection under control. EK Health’s in-house nurse happened to walk by my desk the day I got the call for emergency surgery and I grabbed her. She suggested I get a nurse case manager on the file to coordinate between the surgeon and infectious disease. She knew of the perfect person, in the injured worker's area, so that travel expenses would not get out of control. She spoke with her supervisor who also agreed that a nurse would be the best plan. She is going to make the referral and follow up on everything. I feel that EK Health’s in-house nurse has gone above and beyond for me on this case. She has made my job easier by taking over the referral process. She could have very easily given me the name of a nurse in the area and left the rest up to me.”
-Senior Claims Examiner, a Major Insurance Company

Thank you to EK Health's nurse case manager for making a world of difference for the injured worker as well as myself! EK Health has been extremely helpful!
-Senior Claims Examiner III, a Large Insurance Company

Thanks for always being such a great resource to me and being such a supportive partner with our files.
-Sr. Claims Examiner