New Company, New Mission
We established Southeastern Medical Case Management in 2007 to bring a new level of Advocacy, Accessibility, and Affordability to the growing field of medical case management. It is our goal to bring our many years of professional medical experience to bear by providing timely and complete care that meets the needs of clients, Providers, and administrators.
Southeastern Medical Case Management is proud to be a Service-Connected, Disabled Veteran-Owned business and member of the Asheville, NC Chamber of Commerce.
Definition & Philosophy of Medical Case Management
Case management is an area of specialty practice within the health and human services profession promoting advocacy, communication, and resource management to bring about quality and cost effective medical outcomes. Its underlying premise: everyone benefits when clients reach their optimum level of wellness, self management, and functional capability.
How Case Management works:
Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the heatlth care options and services required to meet client health and human service needs.
We facilitate client wellness and autonomy through advocacy, communication, education, resource management, and service facilitation. Based on the needs of the client - and in collaboration with all services providers - case managers link clients to appropriate providers and resources throughout the continuum of health and human services care settings, all the while ensuring the care provided is safe, effective, client-centered, timely, efficient, and equitable.
Case managers facilitate direct communication between the client, the payer, the primary care provider, and other service delivery professionals to achieve optimum value and desirable outcomes for all parties involved.
Case Management Qualifications:
Certification determines that the case manager possesses the education, skills, knowledge, and experience required to render appropriate services delivered according to sound principles of practice. Case managers are medical professionals enhancing health services by maintaining the client's privacy, confidentiality, and safety while adhering to strict ethical, legal, accreditation, certification, and regulatory standards of guidelines.
Types of Case Management
Workers' Compensation Case Management:
In today's competitive business atmosphere, it is crucial to reduce disability cost and absenteeism while keeping employees healthy and working. At Southeastern Medical Case Management, we work with medical providers, disability carriers, and employers administrating short and long term claims. Our Certified Medical Case Managers and Certified Vocational Rehabilitation Case Managers first assess each individual's level of physical condition, psychological functionality, and work abilities before implementing an individualized care plan that will progress towards medical improvements and claim closure.
Our services include:
Vocational
- Employability Assessments
- Vocational Assessments
- Transitional Skills Assessments
- Labor Market Surveyes
- Evaluation of Suitability
- Disability Assessments
- Job Analysis, Job Development, and Placement
- Vocational Testing
Medical
- Medical Chart Reviews
- Field Medical Case Mangement
- Telephonic Medical Case Mangement
- Medical Bill Review
- Utilization Review
- In-Hospital Field Assessments
- Life Care Plans
- Medical Examination Coordination and Referral
Medicare Set-Aside Allocation:
Southeastern Medical Case Mangement provides services enabling claims professionals, structured settlement brokers, and legal professionals to comply with requirements set by Medicare Secondary Payment Statute (42 U.S.C.1305 y (b)(2) (A) and (B)).
Workers' Compensation Medicare Set Aside Trust Allocation Report services are complex and ever-changing. Southeastern Medical Case Management works to review the claim prior to settlement, identifying if a Set-Aside Trust Allocation is indicated based upon criteria disseminated by Medicare. We then provide services from Initial Assessment to full Set-Aside Trust Allocation Report completion.
Our services include:
- Case evaluation determining if Set-Aside Allocation will be required by the Center for Medicare Services
- Medical records review & cost analysis report preparation for the Center for Medicare Services approval if Set-Aside is indicated
- Breakdown of Medicare and non-Medicare costs
- Approval obtainement of Set-Aside amount from the Center for Medicare Servicers/Medicare (requiring completion of steps 1 & 2)
Medical Cost Projects & Certified Nurse Life Care Planning
Southeastern Medical Case Management provides individualized and comprehensive Life Care Plans projecting the current and future needs for clients suffering from a catastrophic event or injury. Life Care Planning eases the burden of disease and/or injury, preventing possible complications while promoting a meaningful quality of life, providing disability-sensitive recommendations, and establishing expenses involved.
A Certified Life Care Planner performs these services, completong the file review, and constructing an individualized, detailed, and accurate Life Care Plan. Our future-care case planning and projection includes:
- Brain Injury
- Spinal Cord Injury
- Stroke / Celebral-vascular Accident
- Chronic Pain
- Burns
- Personal Injury
- Medical Malpractice
- Birth Defects