[MCOH-EH] Worker's Compensation

Darlene Sims Darlene.sims at infirmaryhealth.org
Mon Jul 1 08:22:34 PDT 2019


Workers' Compensation is a part of  HR at our system and oversee a population of approximately 5,700 employees at multiple sites (hospitals/clinics).
All claims are managed by a Workers' Compensation Specialist, who is a non-clinician and works directly with PMA. (This role is under the purview of a HR Director) We use a TPA for all claims management, approvals, setting reserves, paying benefits, and invoices. The TPA we use is PMA.
Legal issues, court hearings etc., are through HR and the organizations workers' compensation attorney.

Our Employee Health and Safety department is the first line in workers' compensation claim treatment - where an employee is seen by a nurse and NP if needed.  A case manager is assigned to all claims that are on going.  The director of our Employee Health Department is a NP.  
If an injured employee requires a higher level of care, then a referral is made to an occupational health MD (emergency room is used for after hours injuries that require immediate treatment);  All return to work releases must be evaluated through our Employee Health Department This has been our structure for several years

A annual claims stewardship review is held with Executive Team, which includes, Risk and Finance, so that ongoing claims and reserves are adequate as well as monitoring the efficiencies of the TPA.

Darlene Sims, MSN, FNP-C
Director, Infirmary Employee Health Services
Responding for:
Judy Stitt
Director, Infirmary Health Human Resources
Benefits, Employment and
Regional Staffing Pool
Office:  251.435.2211
Direct:  251.435.5720


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Today's Topics:

   1. Re:  Worker's Compensation (Jerry Burleson)


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Message: 1
Date: Mon, 1 Jul 2019 15:08:11 +0000
From: Jerry Burleson <Jerry.Burleson at nhrmc.org>
To: MCOH/EH <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] Worker's Compensation
Message-ID:
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She was a field WC Case Manager prior to her employment here.


Jerry L. Burleson, RN, MBA
Manager, Employee Health and Clinic
New Hanover Regional Medical Center
PO Box 9000
Wilmington, NC 28403-9000
(910) 667-5663 ? Office
(910) 612-8770 ? Cell
(910) 667-5695 ? Fax
Jerry.burleson at nhmrc.org<mailto:Jerry.burleson at nhmrc.org>

Leading our Community to Outstanding Health

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[Forbes Best Logo] [Forbes 2019 CL crop]   [cid:image004.jpg at 01D51AEA.77058EA0]   [cid:image003.jpg at 01D51616.C7FC7400]

Confidentiality Notice: If you are not the intended recipient of this message, you are not authorized to intercept, read, print, retain, copy, forward, or disseminate this communication, its enclosures or attachments. This communication may contain information that is proprietary, confidential, protected health information (PHI) which is subject to HIPAA privacy and security guidelines, or otherwise legally exempt from disclosure. If you have received this message in error, please notify the sender immediately either by phone (910.667.5307) or by return e-mail and destroy all copies of this message (electronic, paper, or otherwise).

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Charles Hackett
Sent: Monday, July 1, 2019 10:17 AM
To: MCOH/EH <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] Worker's Compensation

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Thank you
What is the background of the case manager Charlie Sent from my iPhone

On Jul 1, 2019, at 10:12 AM, Jerry Burleson <Jerry.Burleson at nhrmc.org<mailto:Jerry.Burleson at nhrmc.org>> wrote:
Our organization is approximately 7,500 employees with Employee Health responsible for the entire WC program and reporting to the CHRO.
We are self- insured using a TPA for claims management.
I currently have a dedicated WC Case Manager as the liaison/resource for the injured employee and the TPA.
Risk Management is not involved with the WC process We have ACPs that initially manage the injured patient and refers out to specialists as needed.

I have been recently pondering if the Case Manager is benefitting our organization or could the TPA include this service.

Thanks.


Jerry L. Burleson, RN, MBA
Manager, Employee Health and Clinic
New Hanover Regional Medical Center
PO Box 9000
Wilmington, NC 28403-9000
(910) 667-5663 ? Office
(910) 612-8770 ? Cell
(910) 667-5695 ? Fax
Jerry.burleson at nhmrc.org<mailto:Jerry.burleson at nhmrc.org>

Leading our Community to Outstanding Health

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From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Charles Hackett
Sent: Monday, July 1, 2019 9:38 AM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: [MCOH-EH] Worker's Compensation

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We report into HR at our system and oversee a population of approximately 15k employees at multiple sites.
Our EOHS department has historically managed every aspect of WC.
We use a TPA and are going through a RFP. We have had a nurse manager in the role of overseeing the TPA and interfacing with our employees when they are first injured and are involved through directing care to help with returning to work and a pretty vibrant modified work program.
Our management is questioning the value of a clinician in that role.

How is the management of workers compensation structured within your organization?
What role does your employee health/occupational health team play?
Do you have a dedicated manager and what is their background?
Where does risk fit into the overall scheme of things?
Do you have dedicate clinicians involved in your program?
Thank you
Charlie Hackett MD, MPH, Lifespan EOHS

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