Paradigm

Case Management

Fidiam Guerrero

702-477-5515

Walnut Creek, CA

Paradigm is an accountable care management organization focused on improving the lives of people with complex and catastrophic injuries and diagnoses. We have been a pioneer in value-based care since 1991, offering deep clinical expertise, high-value specialty networks, behavioral health support, payment integrity solutions, and robust data analytics to generate the very best outcomes for patients, payers, and providers. Paradigm is headquartered in Walnut Creek, California, with offices across the U.S. For more information, please visit www.paradigmcorp.com.

Paradigm Clinical Solutions – Care Management Services:

Medical Field Case Management:
Our medical field case managers are registered nurses, working on the ground to coordinate and attend provider visits in order to ensure the proper level and quality of treatment is delivered. This is accomplished by facilitating effective communication between all involved parties; namely the insurer, physician, employer and injured worker. Medical case managers perform in person, virtual and telephonic visits, as deemed necessary to return the injured worker to work. They also plan for, and document maximum medical improvement. Medical field case managers continually analyze their ability to affect a file and realize cost containment recommendations. They focus the injured worker on activities that maintain motivation in order to regain health and return to work.

Telephonic Case Management:
Our team of telephonic nurse case managers provides the same level of service as our medical field staff, often earlier in the life cycle of a claim. The result is immediate, efficient, and cost-effective care as well as successful return to work. Most impactful within the first 90 days after an injury, telephonic case management reduces lost time, promotes faster healing, puts a “friendly nurse face” on the claim and assures medical care is on track for maximum healing. Paradigm specializes in customized telephonic programs, currently in place for many of our customers.

Nurse Triage:
Available 24/7/365, our nurses speak on the phone with the employee to assess the injury and provide skilled recommendations for medical treatment. Utilizing the acclaimed Telephone Triage Protocols for Nurses by Briggs, our nurses advise and inform all parties in real time, offering comprehensive reports immediately after triage. When our nurses determine an injury requires immediate medical attention, they are quickly able to seamlessly connect the worker with a telemedicine provider to assess and treat the injury. Paradigm features a secure technology platform, from which our nurses can conduct virtual video assessments of a worker’s injury to recommend the appropriate type and level of care. Standard Service includes the initial triage call with the injured worker and subsequent report emailed to whoever the contact(s) are on the account, a follow up call on self-care injuries and a phone call and fax to the treating facility.

Transitional Return to Work (TRTW):
TRTW is a program that provides an injured worker temporary employment opportunities, within their work restrictions, when their employer is unable to accommodate their restrictions. Work site placement is typically with non-profit organizations. TRTW facilitates early return to work and gives injured worker an opportunity to contribute with meaningful commitment at a job site. TRTW also successfully focuses the employee’s attention on abilities rather than “disabilities” and helps with self-esteem, sense of productivity, and assists with their vocational recovery.

Pain Products:
Physician Consultative Services:
Paradigm offers a limited review of medical records and pharmacy history by a Medical Director experienced with chronic pain. The Medical Director will attempt to engage the treating provider (within jurisdictional parameters) and discuss current treatment. Paradigm will provide a report with recommendations as to whether Paradigm Team Management is appropriate.

The Claims Education Panel wishes to thank the dedicated insurance professionals and service providers who have given their valuable time and expertise in providing the insurance industry with a much needed and valuable resource.

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Claims Education Panel is a service mark of Ruiz & Associates, Inc.