Paladin's medical Case Management services extend the role of our clients' claims examiners by using health care professionals for expert medical insight. Our services combine physician and field case management to help patients receive the best possible care without incurring undue costs:
Physician Case Management
We assign physicians to any claim that predictive modeling tells could involves six weeks or more of lost work time or other critical factors. Paladin doctors work with our clients' claims examiners to manage the medical aspects of the case by overseeing the patient's medical treatment and approving drug requests. We also make doctors available by phone during normal business hours to consult with claims staff and treating physicians as medical issues arise.
Qualifications for Physician Case Management
- Board certification as an MD or DO
- Current, unrestricted clinical license
- Qualifications to perform clinical oversight for the services provided
- Post-graduate experience in direct patient care
- Completion of continuing education courses, as required by the relevant state licensing board
Field Nurse Case Management
To support our clients' claims examiners with on-site expertise, nurses work with patients and their families in the field to monitor medical services. Each case is managed independently and balances the interests of the patient with those of our client.
Qualifications for Nurse Case Management
- Board certification as an RN
- Case Management Certification (CCM)
- Multi-lingual in areas where a large portion of the population speaks English as a second language
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