Controlling Costs from Work-Related Injuries
An on-the-job injury can include medical care expenses, prescriptions, and lost pay from work. That is why NJM offers services for medical utilization, physician billing review, and case management. We use a comprehensive approach to control costs and help your employees safely return to work as soon as possible.
In fact, our average medical cost per claim in New Jersey is 30% below the State average.†
How do we do it?
Our Managed Care Organization network includes occupational medicine centers, physical therapy centers, physicians, imaging facilities, acute-care and rehabilitation hospitals, and other providers. This gives the injured or ill employees easy access to care, enhances the quality of care, and increases the effectiveness of care.
NJM has an in-house Medical Utilization Department staffed with registered nurses and other certified healthcare professionals. The Department provides:
- Medical case management
- Utilization review
- Physician bill review
- Quality assurance/continuing quality improvement
These healthcare professionals provide expanded support and medical expertise to the claims and legal staffs, ensuring that healthcare services are utilized responsibly, and medical treatment is appropriate for the work-related injury. They help injured employees return to work as quickly as possible and consult with NJM’s attorneys and claims adjusters daily.
Depending on the state, NJM either utilizes its team of experienced in-house attorneys or retains respected outside counsel to represent our customers in workers’ compensation matters.
NJM also offers a pharmacy benefit to our workers’ compensation insurance policyholders. Our program covers the cost of prescriptions for employees who become sick or are injured at work with no out-of-pocket expense. The program is accepted by most major pharmacy chains.
NJM believes that superior customer service requires more than just handling claims. Please reach out to your NJM representative if you have any questions.