Case management in a health maintenance organization: improving quality of care

1. Given the current climate in the health care industry, the occupational health nurse can take the opportunity to formalize the case management role. 2. A unique aspect of case management within the structure of a health maintenance organization allows for effective use of existing internal services and occupational health staff. 3. In developing an occupational case management model, a framework was constructed to include the core aspects of management for all injured workers. A four level system was developed to meet the injured workers' need for the coordination of care and, when indicated, intensive case management. 4. Improved quality of care for the injured worker and a return to an optimal state of health and productivity is already being realized. Formalized evaluation will provide objective measurements of program efficacy and future planning.