CMSA Today - Issue 5, 2011 - (Page 13)

A Managed Care Poem A Managed Care Poem BY JUANITA CALFA, RN, CCM “Hello this is Managed Care. Repeat that please....you fell from WHERE?” Please sir, don’t go beserk. We’ll get you right back to work.” Rotator cuffs, bum knees and backs. Some days it’s more than we can hack. But in this case, I’m calling the claims professional pronto This guy is ready to return to work tomorrow. Gather the facts, use your head We need to put this claim to bed. Collaborate and work as a team. This will go down without showing a seam. “Hold it, he’s not ready” As the claimant’s advocate, the case manager holds steady We’re looking for a good outcome for everyone. Mistakes and hurriedness can cost a ton. Do what you must to figure it out. Watch for progress and don’t be in doubt. Provider, insured, adjuster ...talk with them all But remember, don’t discuss it at the Mall. We’re medical detectives some people say. Medical case management plans are our way. We budget, communicate and plan We always do the best job we can. “Hello sir...I called to say Goodbye. I’m so happy you’ve reached MMI Be careful when you go back to work today Remember...Safety is the best way.” About the Author Juanita Calfa, RN, CCM, of Colorado Springs, Colo., is a CMSA member and is employed by Zurich Services Corporation as a telephonic nurse case manager in the Managed Care Unit. ISSUE 5 • 2011 • DIGITAL CMSA TODAY 13 http://www.cmsa.org

Table of Contents for the Digital Edition of CMSA Today - Issue 5, 2011

President’s Letter
Case Managers are Critical to Decreasing Fragmented Care
A Caregiver’s Emotional Journey Helps in Development of Valuable Case Management Resource
A Managed Care Poem
Case Managers in the Spotlight: The Impact of Case Management on Nursing Leadership and Health Care
CMSA and NASW Launch the CMI Case Load Capacity Calculator
Health Plan Accreditation and Health Care Reform
Association News
CMSA Corporate Partners
Index of Advertisers

CMSA Today - Issue 5, 2011

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