Our Medical Oversight group continually monitors the drug transactions following our Peer Review intervention and during the period of weaning and discontinuance. The purpose of this group is to be expressly focused on instigating accountability for the attending physician to implement agreed upon treatment changes. By doing so the Medical Oversight team helps to take the burden of successful implementation off of the desk of both the claims handler and the nurse case manager.
As part of this process the prescribing physician’s office is contacted in conjunction with ongoing office visits to provide accountability for the treating physician with regard to modified treatment plan. This engagement typically continues monthly until the recommendations have been fully implemented or the client’s representative is satisfied with the current progress.
PRIUM’s oversight personnel are able to work with the client’s representative to coordinate next steps, whether those be clinical or legislative in nature. Clinically this team can assist in finding providers for necessary alternative therapy services such as cognitive behavioral therapy, outpatient medication weaning, inpatient detox and more. Using Medical Oversight as the touchpoint for care coordination helps to provide injured workers with multidisciplinary care which can improve outcomes and ensure that treatment course correction is not inhibited by administrative friction.
Medical Oversight is a highly experienced group overseen by nurses that are versed in national and jurisdictional regulations. Should an attending physician be resistant to pursuing improvements to provided care, Medical Oversight, along with our Compliance/ Regulatory consulting team, will be able to highlight available options and best next steps.