MEDICAL CASE MANAGEMENT 

SRS Philosophy  

Both employees/insured and attending physicians must be comfortable and satisfied with the quality of care offered. However, SRS maintains the approach that creative planning can result in the extension of health care dollars.

 Medical Case Management (MCM) is  provided by SRS Medical Case  Managers, all of whom are licensed nurses with special MCM training. MCM  professionals act as advocates for the  employee/insured through multiple levels  of the health care system.

Assessment  

Case Managers conduct initial screenings to assess the potential for moving the insured through the health care system. Following a determination that the patient would benefit from Medical Case Management, initial reports for the claims payor or client is generated. Reports usually include past medical history of the individual, present status, plan of treatment by the attending physician and appropriate providers


Reporting  

SRS provides a variety of management reports including initial assessment with appropriate alternative care, monthly interim reports and final reports. Our sample reports give you a look at the information we provid.













          Sherry L. Douglas, LVN
          Medical Case Manager

Case Management Selection  

Since our founding in 1990, we have provided clients with diagnoses, injuries and cost parameters requiring alternative case services including:

Premature Labor  
Premature Birth  
Congenital Anomalies  
Spinal Cord Injuries  
Head Trauma  
Multiple Fractures  
Burns  
Amputations  
AIDS/HIV  
Stroke  
Malignancies  
Cardiac Condition  
Respiratory Insufficiency  
Apnea  
Hypoventilation Syndrome  
Renal Failure  
Neuromuscular Disease  
Organ Transplant  











 Stacey Faour, RN - Medical Case Manager

High Risk Pregnancy & Management Program  

Complex pregnancies, labor and delivery are exerting serious financial pressures on benefit plans. In a given year, the costs of complicated prenatal and birth care can cost plans $300,000 or more. Premature births and low birth-weight births often revolve around high risk factors, which greatly stress new parents and run into the millions of dollars.

This new service calls for SRS Prenatal Risk Assessment Reviewers trained in pregnancy and delivery issues to work with expectant mothers early in a pregnancy and takes them through SRS’s Start Right screening program. An expectant mother’s clinical history will be compared against the SRS list of high risk factors. 

High risk factors will establish a cause for reviewers to contact the insurer to request Prenatal Case Management. In this scenario, SRS healthcare staff members act as a patient resource, coordinating care of patient in conjunction with the attending obstetrician and to assure that all cost-effective and appropriate measures are taken to support a healthy delivery. For those women whose pregnancies are not considered high risk, reviewers will pre-certify the hospital admission and follow the case to delivery.

Copyright © 2014, Spectrum Review Services, Inc.  All Rights Reserved





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