Winners of preeminent case management award show resilience during an unprecedented year
In a year when pandemic restrictions put the world on pause, Genex Services’ case managers kept going, determined to help injured employees regain function and return to work in a timely manner. Such successful acts of perseverance resonated in each nomination received for the 5th annual Heart of Case Management Awards and the four winning cases selected for this year’s honors reflect the best of these individual acts of excellence.
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Held this year in conjunction with National Case Management Week (Oct. 11-17), the Genex Heart of Case Management Award recognizes four case managers who have made the greatest impact on the injured employees they served. Now in its fifth year, the Heart of Case Management Awards is a national program recognizing Genex case managers who are highly regarded for transcending beyond their traditional job duties to improve the lives of thousands of injured employees each year. The four winners were nominated from a field of more than 1,600 Genex case managers across the country and judged on the following criteria: specialist, excellence, adaptability, trust, influential communication and outcomes.
Among this year’s winners is a case manager who worked tirelessly to keep a homeless injured employee off the streets so she could recover and avoid contracting COVID, another who advocated for an amputee to receive a highly functional hand prosthetic to return to full duty and a bilingual case manager who broke down cultural barriers to help four employees who sustained serious burns get the care they needed to heal and get back to their jobs.
Watch this video to see how case managers moved claims forward during COVID-19.
The following are synopses of the winning entries.
Catastrophic Case Management
Kayla Payne, RN, BSN, CCM
A 45-year old man working on a conveyer accidentally had his hand get stuck in an augur. The immense trauma he experienced was intensified by the tenuous process of safely releasing his hand from the machine — a 30-minute ordeal. Finally freed, the man was rushed to the local emergency department (ED) where he was diagnosed with a crush injury. Payne was assigned to the case and met the injured employee at the hospital. A hand surgeon was called in and it was determined the man would require below-elbow amputation of his left arm. Prior to becoming a case manager, Payne had worked as an ED nurse at the same hospital where the man was being treated. Her experience and relationships with medical staff allowed her to quickly report the necessary information to the adjuster to begin the treatment plan. After extensive surgery, Payne developed a return-to-work plan, communicating realistic outcomes to the adjuster and the employer. When the specialist recommended the injured employee be fitted with an electrical hand and a gripper prosthesis, Payne became educated on the prosthesis, so she could address the injured employee’s questions and concerns. Through her efforts, the claimant was released to light duty in a sedentary role 36 days after the incident and back to full duty in three months with few job modifications and a savings ratio of 6:1 ROI.
Disability Case Management
Mariana Diaz, BA, CPDM
Four plant employees attempting to free up a plug in an asphalt-filled line were sprayed with 25 gallons of asphalt after the tank opened up. The men were rushed to the hospital where they were diagnosed with multiple third-degree burns, which eventually led to skin grafting and laser scar treatment. As a bilingual Integrated Disability Case Manager (IDCM) assigned to a major manufacturer of building and remodeling supplies, Diaz employs her cultural expertise in managing her cases and often assists other case managers with communication with Spanish-only speaking employees and families. She leveraged her understanding of cultural differences, assisted with breaking down barriers and worked with a Genex field case manager assigned to the case to help coordinate return to work, meeting each employee’s individual needs. Her efforts helped all four workers return to their jobs in a safe and efficient manner, within a time frame of just 26 to 67 lost days per case.
Field Case Management
Rebecca Almskog, RN, BSN, CCM
A 64-year-old employee working at a grocery store distribution center slipped on ice while inspecting a truck entering the facility. She was diagnosed with a stable pelvic fracture, which required rest and stabilization. Soon after being assigned to the case, Almskog learned the claimant had been living in her car at the time of the injury and worked on establishing trust with the injured employee, who was initially reluctant to reveal her homelessness and staying at a friend’s house during recovery. Soon after, though, Almskog noticed that the claimant’s daily hygiene habits began to diminish and realized her current living conditions were not conducive to recovery. She used her critical thinking skills to determine how to keep the injured employee, who was living with several comorbidities, off the streets and in a safe environment to heal. Almskog managed to have the woman placed at a skilled nursing facility, where she would receive therapy five days a week and have her medication regimen and glucose regularly checked. The injured employee thrived in the environment and was recovering well, but as the COVID-19 pandemic hit the U.S., the facility needed to open beds and planned to discharge the woman early. With no place to go and no modified duty available from her employer, the woman was headed back to the streets. Once again, Almskog began looking for alternatives. When she learned the claimant had a brother in Texas, Almskog called the sibling who agreed to let his sister stay with him, if she could get to Texas. She then contacted the adjuster who agreed to settle the claim and Almskog arranged the trip to Texas. When discharged from the facility, the claimant had one pair of pajamas and her work uniform. The case manager procured clothes and a warm coat before the employee flew to Texas. Today, the woman is healthy and happily retired living in her own apartment in Texas. Almskog’s actions on this file resulted in an ROI of 3.10 cost savings, but most importantly, she likely saved a life.
Telephonic Case Management
Dianna Zellerman, RN, BSN, CCM
A 47-year-old paraprofessional slipped and fell on an icy pavement, injuring her right foot. While X-rays showed no evidence of fracture or dislocation, the woman still experienced severe pain. Once assigned to the case, Zellerman compared the treatment plan with guidelines and projected duration of disability. When the employee expressed concerns regarding her diagnosis, restrictions, treatment recommendations and overall care received from occupational medicine, Zellerman worked with her to develop a return-to-work plan and, in collaboration with the resolution manager, decided to transfer care to an orthopedic specialist. The physician immediately recommended an urgent MRI to rule out Achilles tendon rupture and confirmed diagnosis of tendinitis. These efforts enabled Zellerman to establish trust with the injured paraprofessional, who remained responsive to the case manager and compliant to the care plan. Zellerman assisted with communicating updated work status to the employer to ensure timely return to light duty when it was previously not available. Through these collaborative efforts and timely referrals, the injured worker was able to return to light duty and was subsequently placed at maximum medical improvement soon after. This resulted in only 17 days lost time compared to the projected estimated length of disability of 158 days.
More in-depth information on each case management story can be found at www.genexservices.com/fromtheheart.
About Genex Services
Genex Services (www.genexservices.com) provides best-in-class clinical solutions that enable customers to transform their bottom lines while enhancing the lives of injured and disabled workers. Genex, a clinical management leader throughout North America, serves the top underwriters of workers’ compensation, automobile, disability insurance, third-party administrators and a significant number of Fortune 500 employers. In addition, Genex clinical services are enhanced by intelligent systems and 360-degree data analysis. Its clinical expertise consistently drives superior results related to medical, wage loss, and productivity costs associated with claims in the workers’ compensation, disability, automobile, and health care systems. Genex, Mitchell, and Coventry have recently combined their joint industry expertise and advanced technology solutions into one organization to simplify and optimize property, casualty and disability claims processes and services.
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