As treatment and productivity options advance, employers must stay connected to the latest solutions for quality care centered on helping employees recover. We offer a wide range of employee care solutions and many types of review and support services to meet your needs.
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No matter what managed care options you’re seeking, we will work to design a program that streamlines workflows and makes your team’s job easier.
Contact usIntegrated approach – the power of one
Sedgwick’s integrated solution includes comprehensive claims and managed care services that provide a personal connection with the employee, beginning with the first conversation and continuing through recovery. Our outcome-focused approach includes identifying top-performing providers, coordinating the claims process, and using clinicians, physicians, pharmacists and other specialists to help as injured employees recover. In addition, our advanced technology supports every aspect of our services. With our viaOne suite of tools, clients can analyze their claims information and run claims and managed care reports all in one place. With mySedgwick, our online self-service tool, clients can see which employees are off work at any time and injured employees can view claim details, easily update information and keep the process moving forward. Learn more about our integrated approach.
Independent approach – the power of choice
We recognize that claims organizations, insurance companies, public entities and self-administered employers have different systems, needs and workflows. When you choose Sedgwick, you not only get our clinical expertise, sophisticated technology and best-in-class solutions, you also get flexibility. Our independent managed care solutions give clients the power to choose just one or several from our full suite of services. Cost containment and clinical care services can be engaged individually to complement an existing managed care program, or they can be provided as an independent, but connected program. Whether you need managed care solutions for a workers’ compensation or liability program, we offer many options to meet your needs. Learn more about our independent approach.
No matter what managed care options you’re seeking, we will work to design a program that streamlines workflows and makes your team’s job easier. By providing the right care and coordination solutions – from clinical case management to networks and support – along with the best treatment and cost oversight, we’re driving better outcomes for everyone involved.
We understand the importance of early and appropriate treatment of workplace injuries. Our 24/7/365 clinical consultation/nurse triage solution helps employees receive safe, appropriate care at the time of injury. Our registered nurses are trained in occupational injuries and use industry-proven guidelines to recommend first aid/self-care, telemedicine or in-person care with a local provider associated with the highest quality treatment outcomes. The clinical team also works with our utilization review (UR) nurses to ensure the best treatment levels. If the requested treatment falls outside of the medical guidelines, the UR nurse will engage a physician advisor who will consult with the treating provider on alternative strategies.
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Engaging our nurse case managers helps control costs and ensures injured employees receive the care they need. Our skilled case management team identifies comorbidities and coordinates with claims examiners to deploy specific strategies to mitigate costs and promote safe, appropriate care and activity for each injured employee based on their situation.
Telephonic case management
Our telephonic case managers work closely with the injured worker, treating physician, employer and adjuster to ensure the best medical options are utilized. It is the most cost-effective means of assuring proper medical care coordination.
Field case management
We provide field case management services for injuries that are more severe or complex. On-site nurses are available to accompany the injured employee to medical appointments and can discuss a return to work strategy with the provider based on the functional ability of the individual.
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Our surgery nurse solution helps injured employees facing surgery to be better prepared physically and mentally, and to confidently steer themselves toward a faster recovery. A specialized surgery nurse engages the employee with a pre-habilitation/rehabilitation model designed to prepare their mind and body before surgery to improve the outcome and recovery.
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Medications, compounds and opioids prescribed for workplace injuries can present serious safety issues. Without careful oversight, they can often lead to long-term dependency and abuse. Our pharmacy solutions help control the use of these drugs with an approach that puts the injured employee’s health and safety first.
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When an employee is injured on the job, Sedgwick’s goal is to ensure they get back to health and work as safely and quickly as possible. Our experts provide several key services to facilitate safe and healthy stay at work and return to work options. We also offer transitional work placement as an alternative solution for employers that are unable to provide modified duty positions for injured employees. Our team identifies temporary work opportunities with not-for-profit organizations in the employee’s community and oversees the process.
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Our behavioral health specialists serve as patient advocates and provide the expert assistance needed to identify and address psychosocial barriers to ease the return to work process. Our specialists offer clinical expertise, guidance and support for injured employees and those with mental stress claims. They can also help identify additional problems within a claim that need to be addressed. Behavioral health specialists can make an impact on claims involving trauma, mass casualty and catastrophic incidents, assaults and robberies, or when psychosocial flags are noted such as drug abuse, financial difficulties, family or relationship challenges, stress or fear about returning to work.
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Our crisis care program provides 24/7 resources to assist employers and claims professionals with violent workplace events, catastrophic injuries and complex clinical situations. One call to our crisis care hotline provides access to a crisis care nurse, who will deploy the appropriate resources including mental health experts, field case managers, physician advisors and specialized medical equipment experts.
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Our dedicated care coordinators offer concierge-level support and connect employees with best-in-class services to help them on the road to recovery. We manage requests for many types of ancillary services including durable medical equipment, home health, diagnostic imaging, translation and language, and transportation and travel support. Our networks include more than 40,000 providers and we offer a 48-hour scheduling guarantee for all services, as well as same day or next day service for urgent requests.
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Sedgwick’s five-star provider benchmarking program helps us build superior networks to ensure quality care for injured employees and drive positive results for clients. When possible, injured employees are matched with local providers with the highest scores.
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Our expert bill review team and customized technology allow us to achieve the highest possible savings for our clients. We analyze all bills to ensure charges are billed accurately and we pursue all bill reductions and other discounts to make sure we reduce costs as much as possible. For clients using our integrated services, our bill review system is electronically connected with our claims and case management platforms, allowing utilization review decisions to be applied automatically. Our independent bill review services integrate with your claims system and processes, offering a streamlined approach designed to improve efficiency.
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Every day, thousands of people turn to Sedgwick when faced with a life-changing moment. They work for global brands that want to provide the best coverage for the people they value most. They are big and small business owners who need to get things back on track. And they are employees and consumers who need to know that they’re protected. We take care of them when they need it most, helping them get back on their feet, back on the road, back to business as usual – because caring counts.
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Workers' Compensation Utilization Management
Expires 05/01/2024
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