How One Call’s Care Navigators Go the Extra Mile to Aid Injured Workers

1 month ago

How One Call’s Care Navigators Go the Extra Mile to Aid Injured Workers

How One Call’s Care Navigators Go the Extra Mile to Aid Injured Workers
Comprehensive, collaborative, and consistently communicated care are key to a workers’ compensation risk management approach.

One of Teletha Burnett’s most fulfilling experiences as a Care Navigator with One Call was when she helped an injured worker become the parent he wanted to be, despite his catastrophic injuries.

A workplace accident left him unable to walk, and doctors said the condition might be permanent. He was young, in his 30s, and expecting to be a father.

“He was concerned about being able to hold his child, walk around, and play an active role in her life growing up,” Burnett said.

As the Care Navigator assigned to his claim, 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 and be an active father.

The injured worker completed the program and by the end of it, he was walking around his neighborhood cul-de-sac holding his daughter.

“He's able to walk around and take care of his baby,” Burnett said. “He is so happy and fulfilled.”

His incredible story is a testament to the advocacy of One Call’s Care Navigators — a team of dedicated professionals who help coordinate catastrophic and home health claims from start to finish.

What Role Do Care Navigators Play in Claims?

Cases sometimes include multiple referrals from different physicians that require approval of numerous services, therapies, medical equipment, supplies, transportation, and language services. It can be challenging to make sure all the moving parts are working together to produce the best outcomes. 

One Call launched the Care Navigator program in 2019 to support adjusters and case managers by providing them with a holistic view of the in-home recovery. In doing so, adjusters and case managers are better positioned to provide injured workers with the care they need when they need it.

“The Care Navigator brings everything together,” said Kimberly Thomas, director of operations for One Call. “One person stays with the injured worker, develops relationships, advocates, keeps things moving, and ultimately, tracks their progress toward recovery, return to health, and return to work.”

Care Navigators receive claim documentation, relevant medical records, and notes from conversations with nurse case managers and adjusters. This access gives them a birds-eye-view of relevant aspects of the claim, so they can help to eliminate silos and streamline an injured worker’s recovery journey.

“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 Thomas. “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.”

Benefits of a Care Navigator: The 4 C’s

Thomas and Burnett see four main benefits to using Care Navigators on complex and home care claims – the four C’s: comprehensive, collaboration, communication, and consistency.

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 in-patient facility if they cannot go directly home from the hospital,” Thomas 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 necessary medical and respiratory supplies and may schedule diagnostic and outpatient physical therapy appointments.”

2) Collaboration: This comprehensive view also enables Care Navigators to build relationship with all parties involved, breaking down silos along the way.

“We review the clinical paperwork that comes over and notate anything that’s possibly missing,” Burnett said. “As the main point of contact for One Call’s services, we then collaborate with the nurse case manager and adjuster on next steps.”

3) Communication: Care Navigators work to answer everyone’s questions, most notably from the injured worker and their family as they navigate the often-complex recovery pathway.

Thomas shared that in the past, Care Navigators have received letters from injured workers and their families thanking them for their support. She recalls one specific letter:

“The family shared that during the recovery process, there were times they felt alone. But even through the toughest times, their Care Navigator was always there to support them and make sure the injured worker had transportation to appointments. The family expressed a lot of appreciation for that connection.”

4) Consistency: Communication is important, but consistent communication is key. Care Navigators consistently communicate with all parties involved in a claim, making sure everyone receives every update. Throughout the entire journey, this regular communication helps to ease anxiety 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.

By placing Care Navigators on these claims, One Call helps to ensure injured workers who need the most attention are getting timely, hands-on treatment and information. Injured workers with traumatic brain injuries, spinal cord traumas, amputations, or complex injuries with comorbid conditions, for example, 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 hung up,” Thomas said.

Care Navigators play a vital role, but it is their purpose-driven approach that truly makes the difference.

By forging genuine trust and emotional connections, Care Navigators help injured workers adhere to their treatment paths and trust the workers’ comp system, making them an invaluable resource for adjusters and case managers.

“We coordinate care from the moment someone gets hurt on the job, advocating on behalf of all of our partners and the injured worker we all serve,” Burnett said. “It’s an incredible opportunity to make a difference in someone’s life, and we feel privileged to be a part of each and every journey.”

This article first appeared in Risk & Insurance.

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