Our flexible case management services are geared to the needs of seriously or catastrophically ill or injured claimants, whether they are insured under health, auto, or workers' compensation. Because experienced management of medical treatment and services benefits both the insured and the payer, URS Case Management should begin as early as possible. Our experienced, dedicated, and certified RN/CCM staff performs all Case Management services.

Our RN Case Managers are knowledgeable in insurance issues and regulations, and can effectively coordinate care and benefits.

Telephonic prescreening is performed on each case to verify the need for any on-site Case Management based on the treatment plan and status of the case, to reduce unnecessary costs to the payer.

With our Case Managers' involvement, clients benefit from:

  • Gaining an early and clear picture of a claimant's treatment, medical recovery, and return to work prospects
  • Projecting short and long term medical and associated costs
  • Facilitating early recovery by coordinating the efforts of treatment professionals and keeping the program on track
  • Conserving and ultimately reducing claim costs by utilizing cost effective programs and suppliers, community resources, and, when available, alternative and more medically appropriate approaches
  • Assisting the employee to the earliest and most feasible return to work
  • Having the Case Manager as a liason between the provider, claimant and adjustor

Cases are managed proactively to facilitate the most appropriate and cost-effective medical care. Network utilization is maximized throughout the life of the case and community and publicly funded programs are utilized when possible to augment private services. Goals are targeted in the initial assessment and the case is closed upon their completion. Lifetime Medical Cost Projections and Medical File Reviews are also provided.

Our program interfaces with the utilization review and claims paying process. Case Managers aggressively manage hospital discharges, avoiding unnecessary inpatient days and maximizing the chances for successful home recovery through prearranging and negotiating for medical equipment, services, and supplies. Case Management assures that each claimant receives the most appropriate level of care available, and prevents unnecessary or duplicate services.

Case Management is billed at competitive hourly rates, or in some cases a fee per covered life, and returns on investment through medical cost reductions range from $7.00 to $10.00 for every $1.00 spent on services.







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