nurse case management services

City of Memphis

Nurse Case Management Services

Kate Kananura PADM : 7603

Project charter

• The City of Memphis ( CMO) has more than 9,000 employees

• CMO offers benefits to all employees injured at work

• Contractor (herein “company”) provides Nurse Case Management Services (NCMS) for administration of On-the-Job Injuries (OJI)

Project Charter

– Initial term of the NCMS a contract is three years, (2013 – 2016) with a renewal option of additional two or one year periods

Resource Needs:

• A licensed certified Nurse Case Manager

• A competent project team

• An automated reporting system

• Efficient medical service providers

•Adequate cash flow

Objectives

• Liaise with COM’s appointed medical service providers

• Develop rehabilitation treatment plans

• Monitor out of network medical treatment

• Ensure employee compliance with treatment

• Formulate plans for safe return to work

• Process all referred OJI cases

High Risk assessment

• Inadequate staffing/lack of relevant

expertise may result into administrative errors and omissions

•Malfunction of the automated system would limit information flow.

•Incompetent medical service providers/ ineffective treatment

Governance

•COM- accountable for contract management

•“Company”- responsible for all NCMS services

•Third Party Administrator (TPA)- designated by the city to processes qualified OJI claims.

Governance

• TPA to process internal quality reviews, formal file reviews, and customer service file reviews.

• Company to Identify accomplishments, obstacles, futures CM plans and projected costs

• Company to ensure provision of monthly cost reports and transaction reports to COM and TPA

Communications plan

•Initial stakeholders meeting to discuss requirements and assign roles.

• Bi weekly project team meetings to discuss accomplishments, challenges and way forward.

• Create an online interactive forum such as dashboard to share project status reports

• Arrange impromptu meetings for emergencies

•Contractor to communicate with TPA as needed

Risk register

Type Description Possible consequence

Prioritization of Risk

Response strategies

Human Risk Negligent, incompetent company staff;

Omissions & errors, delayed claims processing, delayed reports

High Monitor staff, Provide trainings, Motivate staff

Non compliance of injured COM employees

Delayed medical attention & delayed return to work, increased claims

Medium Increase site visits, counseling, COM staff training,

Incompetent/ service providers.

Delayed treatment & medical records; patient’s worsened health; delayed claims processing.

High Maintain a pool of competent network and out- of -network service providers.

Technology Risk

Malfunction of the automated reporting system.

No 24 hour access to electronic case notes, delays in case processing

High Create back up files Ensure efficient maintenance of equipment

Financial Risk

Cash flow shortage

Delays or halt in service provision.

Low Reschedule or terminate service as per contract

Media Risk Any project scandal reported in the press

Loss of confidentiality of employee information, COM ‘s image badly tarnished.

Low Ensure efficient services, Address any negative issues promptly.

Risk register (continued)

Evaluation criteria

• Availability of 24 hour case management services to COM employees

• Injured employees must be contacted within one business day of case referral

• Subsequent services, claims reports and claim reviews must be completed within specified timelines of each case category

• Safe creation, maintenance, and transfers of employee files and information • Availability of an automated reporting system • Cost and transaction reports submitted to TPA monthly • Six month’s employee surveys to determine level of satisfaction with NCMS