Case Management
Case Management for Third-Party Entities (Workers’ Compensation, Accident and Health, Long Term Disability Insurance), Special Needs Trusts, and the Population at Large
Coordinating care for chronic conditions and catastrophic injuries demands clinical expertise, in-depth healthcare industry knowledge, and sound methodology to identify deficits, determine needed services, and optimize outcomes. Whether coordinating third-party beneficiary funds, allocating special needs monies, or providing care oversight, we provide the 'glue between the cracks' in the fragmented healthcare delivery system.
Roughan & Associates Qualified Case Management Nurse Specialists Have the Requisite Expertise and Experience that Ensures Coordination of Appropriate Care for Both Adults and Children
The diagnoses Roughan & Associates manages include, but are not limited to:
- Immunodeficiency Syndrome
- AIDS Related Complications
- Amputations
- Anorexia Nervosa
- Anoxic Brain Injury
- Burns
- Cancer
- Carpal Tunnel Syndrome
- Cerebral Palsy
- Cerebral Vascular Accident
- Chronic Pain Syndrome
- Congenital Anomalies
- Diabetes Mellitus
- Erb's Palsy
- Failed Back Syndrome
- Fractured Hip/Knee/Legs, etc.
- Guillain Barré Syndrome
- Head Injury – Closed/Open
- Lymphoma
- Multiple Sclerosis
- Myocardial Infarction
- Near Drowning
- Organ Transplant
- Paraplegia/Paraparesis
- Pulmonary Disease
- Quadriplegia/Quadriparesis
- Reflex Sympathetic Disorder
- Soft Tissue Injury
- Spinal Cord Injury
- Thrombophlebitis
- Toxic Exposure
- Traumatic Brain Injury
- Traumatic Stress Disorder
Additional Referral Indicators May Include:
- Digression from standard of practice
- Unlimited or high dollar liability policies
- Evidence of complications (e.g., infection, decubitus)
- Multiple, poorly-coordinated treatment providers
- Ventilator dependence
- High recidivism rates/multiple hospital admissions
- Unanticipated ICU/CCU confinement
- High claim dollars expenditure
- Need for specialized resources
- Questions regarding treatment or appropriate care
Case Management Consulting Services
Establishing a case management department or practice is costly in both capital expenditure and personnel. Roughan & Associates Consulting Services help maximize return on investment in this vital area while avoiding the costly process of learning by “trial and error.”
Typical Consulting Services:
- Identifying realistic goals and objectives for case management
- Designing case management processes and establishing operating procedures
- Targeting early identification and referral of appropriate cases
- Training and supervision of case managers
- Establishing formats for coverage of needs through cost/benefit analysis
Three Decades of Managing What Matters
Complex cases require professionals who understand treatment protocols, long-term care planning and available resources. Roughan & Associates has navigated every complication and barrier in the pursuit of ensuring continuity of appropriate care.
