Medical Case Management at Generali Global Assistance | Travel Assistance7 April 2020
Today, we celebrate World Health Day and want to say Thank You to Medical Personnel around the world… “Sometimes it is only a matter of having someone to talk to that cares” - Corie Pinero, RN - gives us a glimpse into the world of Medical Case Management at GGA Travel Assistance. #WorldHealthDay #WeCare #CareNeverStops
Medical Case Management can be defined as a collaborative process involving assessing, monitoring, planning and coordinating care for patients. It includes directing patients to the right providers, assisting with the arrangements of transfers and post-discharge planning.
At Generali Global Assistance Travel Assistance (GGA TA) we have 26 registered nurses, known as Medical Case Managers. Our Medical Case Managers are the connection between the hospital and the patients (our client’s members) – ensuring that the patients are getting necessary and appropriate quality care treatment as cost-effective as possible.
Our medical team is guided by the industry’s most reputable criteria when performing medical case management and utilization reviews – using vetted clinical evidence-based medicine to determine proper levels of care. The concept behind Evidence Based Medicine is to make sure that decisions made in relation to health care are based on the most up-to-date, solid, reliable and scientific evidence.
Team Lead, Registered Nurse and Certified Case Manager, Corie Pinero, gives us a glimpse into the world of Medical Case Management at GGA TA – “Our goal is to bring the member from Sickness to Health. Distress to Relief. Anytime, Anywhere.”
Having a solid Case Management Program affords our case managers the tools to provide assistance and oversight to ensure the safest and most effective care to their patients. “We help provide guidance, education and support to members that have chronic or complex conditions. Medical Case Management helps members to improve their quality of life and it also helps to have a person that they can call or write to if they have questions or concerns”, says Corie – Adding that “sometimes it is only a matter of having someone to talk to that cares”.
In order to be a successful medical case manager, having a broad medical background is essential, according to Corie: “You also need to have good listening skills and the ability to think outside the box”. While the process of case management is the same for cases here in the US and the rest of the world, managing cases outside the US has its challenges: “Community resources for member’s overseas can be limited, benefit limitations and differences in medical care. Time difference can be difficult to navigate as well.”, says Corie.
Despite being faced with challenges, she feels that the reward is much greater than the obstacles: “Hearing and reading from our members that their health has improved, that you made a positive impact in someone else’s life.” About working as a nurse in this type of setting where you do not physically see the patients she says: “Just knowing that you are there as support to the member and caregivers by relieving some of the burden, is a reward”.
By serving as an additional layer of assurance that a medical treatment is provided properly, Medical Case Management is an effective cost saving tool. Efficient use of the Case Management criteria strengthens the claims adjudication process, ultimately saving our clients’ money. Also, having a nurse in direct contact with their members who can educate them on how to improve their health and guide them to an alternative plan of care, if needed. “We provide detailed reviews of medical records and intervene when needed, ensuring the best outcome for our clients and their members.”