Workers’ compensation claims can be challenging to manage, even for experienced adjusters. From claim documentation to tracking medical records, many components require smooth coordination for injured workers to receive the care they need at the right time. Home Health and Complex Care cases often involve multiple referrals from different physicians that require approval from multiple services, therapies, medical equipment, transportation and language services.
At One Call, our approach is simple: Care works better when it is connected. With clinical oversight, comprehensive care coordination and ongoing support, we deliver smarter, faster care and amplified outcomes.
One Call’s Care Navigators specialize in coordinating complex cases with many moving parts. For catastrophic cases such as traumatic brain injuries, spinal cord injuries, or amputations, our Care Navigator team handles it all.
One Call launched the Care Navigator program in 2019 to support adjusters and case managers by providing them with a holistic view of in-home recovery. By eliminating silos and creating a single point of coordination, adjusters and case managers are better supported in delivering the right care at the right time.
“The Care Navigator brings everything together,” said Amanda Forgrave, Director of Operations for One Call. “A single, dedicated contact remains with the injured worker throughout their healing journey, offering steady support and advocacy, guiding each step forward and carefully monitoring their progress toward recovery and renewed health.”
Care Navigators receive claim documentation, relevant medical records and notes from conversations with nurse case managers and adjusters. This access gives them a bird’s-eye view of the claim, helping them streamline care and create a more connected injured workers’ recovery experience. “From extensive wound experience to intravenous medications and injections to traumatic brain injuries, our Care Navigators have a wide range of experience. We have nurses experienced with spinal cord injuries and those who have been case managers,” said Forgrave. “All these specialties come together, and when we have a case that fits the background and expertise of a Care Navigator, we match them up.”
When Compassion Meets Coordination
That thoughtful matching process goes beyond clinical qualifications alone. By aligning injured workers with Care Navigators who have both the right expertise for higher intensity levels of care and the right perspective, One Call ensures recovery is supported on a deeply human level.
For Teletha Burnett, Care Navigator Supervisor, one of the most meaningful moments in her role came when she was matched with an injured worker whose life had been forever changed by a catastrophic workplace injury. Through steady guidance and consistent follow-through, she helped coordinate the services that he needed.
A workplace accident left him unable to walk, and doctors said the condition might be permanent. In his thirties and expecting his first child, his concerns extended far beyond mobility. “He was concerned about walking, being able to hold his daughter and playing an active role in her life growing up,” Burnett said.
Burnett reviewed all the notes and documentation associated with his case. During one of her regular update calls with his adjuster and case manager, Teletha suggested Rehab Without Walls, an extensive therapy program that could help him walk again.
The injured worker completed the program and by the end of it, he was walking around his neighborhood cul-de-sac holding his daughter.
“Thanks to his dedication to the prescribed recovery plan, he regained mobility and can take care of his baby,” Burnett said. “He is so happy and experiencing a renewed sense of fulfillment.”
His incredible story is a testament to the advocacy of One Call’s Care Navigators – a team of dedicated RNs and LPNs who help coordinate catastrophic claims from start to finish.
The 4C’s Behind Program Success
1) Comprehensive:
Care Navigators have a comprehensive view into all aspects of an injured worker’s in-home recovery needs, which helps them to coordinate the best care possible.
“They spend a lot of time reviewing documentation, giving feedback to providers and tracking down everything an injured worker needs to recover at home or in an inpatient facility, if they cannot go directly home from the hospital,” Forgrave said. “Armed with this information and in partnership with adjusters and nurse case managers, they arrange services such as in-home nursing and therapies, attendant care and transportation to and from appointments. They coordinate the delivery of medical supplies and may schedule diagnostic and outpatient physical therapy appointments.”
2) Collaborative:
This comprehensive view also enables Care Navigators to build relationships with all parties involved, breaking silos along the way and creating a more unified approach to care. By maintaining visibility into each step of the recovery process, they are able to anticipate needs, address potential gaps and ensure that everyone remains aligned on the injured worker’s progress.
“We review the clinical paperwork and notate anything that’s possibly missing,” Burnett said. “As the main point of contact for One Call’s services, we collaborate with the nurse case manager and adjuster on next steps.”
3) Communication:
Proactive communication is necessary to ensure injured workers and their family members stay informed, supported and confident throughout the recovery process. Care Navigators work to answer everyone’s questions as they navigate the often-complex recovery pathway.
Forgrave shared that in the past, Care Navigators have received letters from injured workers and their families thanking them for their support.
4) Consistency:
Consistent follow-through is essential to supporting an injured worker’s recovery. Care Navigators remain steadily involved throughout the life of complex claims, supporting each step of the recovery plan and keeping progress moving as intended. This dependable involvement helps reduce uncertainty, maintain momentum and keep the recovery journey on track.
The One Call Difference
One Call’s patient-centered solutions are critical to helping improve claim outcomes and return-to-work timelines, particularly for catastrophic or complex claims.
With dedicated Care Navigators supporting these claims, One Call helps injured workers receive timely, hands-on treatment and information. Injured workers with traumatic brain injuries, spinal cord traumas, amputations or complex injuries with comorbid conditions can all benefit from this specialized care.
“Care Navigators are a team of caring, collaborative, expert guides who serve as a conduit between One Call and adjusters, case managers, providers and injured workers. Their ability to provide insight into every facet of a recovery journey helps prevent catastrophic claims from getting stuck,” Forgrave said.
While Care Navigators play a vital operational role, it is their purpose-driven approach that truly sets One Call apart. By unifying every aspect of ancillary care and combining clinical expertise with empathy, advocacy and continuity, One Call delivers more than coordinated care – it delivers confidence, clarity and a better path forward for injured workers and the teams who support them.
Easy Ways to Refer
Send your Home Health and Complex Care referrals to our team and start experiencing the benefits of this best-in-class program.
Email: myrequest@onecallcm.com
Website: https://www.myeasyreferral.com/
Phone: 855-629-6226
Fax: 844-418-0530
This article first appeared in WorkCompWire.
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