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Case Management
MED-VALU case management is the assessment and management of potentially complicated and/or catastrophic illnesses by a well-trained medical professional. The goal of the case management process is to foresee a patient's needs then coordinate those needs with the appropriate level of health care services in a cost effective manner.
MED-VALU Case Managers are required to be registered nurses and possess a Certified Case Manager (C.C.M.) accreditation.
MED-VALU Case Managers ensure that the patients receive high quality care by working with facilities, physicians, and family. They also negotiate prices with vendors to reduce overall claims costs. Combined with the MED-VALU Utilization Review program, there is an increased probability of identifying and managing catastrophic claims. This enables our clients to create better working relationships with their re-insurers or stop loss carriers.
Case management identifies all potential transplant patients. If the transplant is verified as being medically necessary then through a direct contract with
Post Acute Care, Inc.
a case rate is negotiated at the facility. These rates include organ harvesting, post-operation treatment, and drugs. This service has saved MED-VALU clients millions of dollars.
MED-VALU, as part of its utilization review services, identifies at the time of pre-certification,
Expectant Mothers
who may become high-risk mothers. The Med-Valu UR nurse interviews the mother-to-be and the obstetrician's office about any prior pregnancies or any past difficulties she may have experienced. If there are any problems or concerns with the pregnancy, the case will be put into active case management at that time. Through these interventions, MED-VALU helps to minimize the risk of unexpected and unassisted catastrophic claims for the employer and employee.
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Med-Valu, Incorporated
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