Medical Management Services
Extend your managed care expertise with our network of nurses and medical professionals
Sometimes you can’t be sure the specific medical care recommended or already provided to an injured worker is appropriate and necessary. That’s why Mitchell provides Utilization Review(UR) services—for those times when you need additional expert decision-making help at your side.
Our medical nurse professionals work closely with healthcare providers to determine the appropriateness and quality of requested medical care. As a team, they provide prospective, concurrent and retrospective review to optimize treatment of a worker’s injuries at any stage of the claim. We help insurers comply with individually mandated state and URAC guidelines, timetables for utilization review, as well as state reporting of utilization review services when required.
Some clerical functions of the Mitchell International, Inc. URAC-accredited workers' compensation utilization management program are being performed at an offshore location
This subset of UR is based on a predetermined list of services. It is primarily handled by support staff with nurse consultation if needed. A determination letter is sent and data is captured for auditing purposes.
First Level Peer Review
This is a pre-certification of treatment not requiring physician review. The review is completed by a licensed health care professional who evaluates the requested service and all submitted documentation. The licensed professional may certify requests or forward the request to Second Level Peer Review (Physician Review).
Second Level Peer Review (Physician Review)
Utilized in conjunction with First Level UR when treatment is not within guidelines, or a higher level of review is needed by a physician.
Managing an injured worker’s timely rehabilitation and return to work is a team effort. Mitchell Case Management is a critical component in the success of any return-to-work program. Our qualified medical nurse professionals act as patient advocates, and help protect the interests of all parties by coordinating the efforts of healthcare providers, insurance adjusters, the employer and the injured worker.
Telephonic Case Management
- Opiate addiction, especially in the Workers’ Compensation space, is costly and dangerous. Mitchell Pharmacy Intervention extends our managed care capabilities to cover this fast-growing healthcare threat by having our nurses work directly with primary treating physicians and patients to establish weaning programs, set goals and additional clinical medical necessity.
Field Case Management
Mitchell Field Case Management extends your claim management expertise to face-to-face meetings with claimants at designated medical events ranging from doctor visits to surgeries, treatments, and home visits. Clients who have adopted Field Case Management have seen simplified solutions for their adjusters and significant overall cost savings.