Enlyte Announces Winners of 2023 Heart of Case Management Awards
Four professionals who exemplify case management excellence by helping employees meet return-to-work goals following significant injuries are honored
SAN DIEGO – Oct. 11, 2023 – Enlyte, a leader in cost-containment technology, provider networks, clinical services, pharmacy benefit management (PBM) and disability management, has announced the winners of the 2023 Heart of Case Management Awards, a prestigious honor recognizing four individuals nominated by their managers and selected from a field of more than 2,000 case managers across the country.
The national program recognizes four case managers of Genex Services, an Enlyte company, who have made the greatest impact on the injured employees they served, and who are highly regarded for transcending beyond their traditional job duties to help improve the lives of thousands of injured employees each year.
“In a time when there are unprecedented challenges due to a significant labor shortage, the role of the case manager is more critical than ever,” said Tim Howard, SVP, field case management “Not only do these professionals play an essential role in helping injured employees get back to work, but they also provide services designed to restore lives.”
Each year, these professionals are charged with helping thousands of employees who sustain injuries on the job receive the care and resources they need to reach their highest level of improvement. In more critical cases, the severity of injury or illness may not only be mobility limiting, but life-threatening. This was the case for this year’s winners of Genex’s Heart of Case Management Awards, who overcame overwhelming odds to help injured employees meet their recovery goals.
Among this year's winners is a case manager who used her critical thinking skills to allow an Amish builder to return to function following a spinal cord injury. Another uncovered a life-threatening side effect during an injured employee’s recovery from knee injury. Two others ensured an employee who sustained significant burn injuries and a non-compliant claimant received the education, motivation and resources they needed to reach their highest levels of functioning.
Nominees are judged on a multitude of criteria including expertise, excellence, adaptability, trust, influential communication, critical thinking and outcomes. The following are synopses of the award-winning entries.
Field Case Management
Angela Higdon, RN, BSN, CCM
A human resources professional slipped on a wet surface, sustaining a fractured knee injury and concussion after falling and hitting her head on a steel doorway. It was determined that her knee injury wouldn’t require surgery to heal but needed to be stabilized. She was then referred to PT to begin her rehab. Within two weeks of receiving this referral for field case management services, the injured employee called her case manager, Angela Higdon, complaining of worsening medical symptoms unrelated to the knee (increased shortness of breath, chest pain while breathing and lightheadedness). Higdon recognized these symptoms as signs of thrombosis, possibly brought on by leg movement after a period of stabilization. Higdon encouraged the woman to seek emergency care. A CT scan was performed and indicated the employee had a saddle embolism, a rare, but life-threatening condition where a large blood clot lodges at the branching of the main pulmonary artery, blocking blood flow to both lungs. She was quickly admitted to the ICU for treatment and underwent a bronchoscopy to remove the clot. The employee was also placed on a blood-thinning regimen and an IVC filter was implanted to prevent remaining clots from traveling to other major arteries. Following discharge, Higdon coordinated the employee’s cardiology, hematology, neurology and orthopedic appointments to monitor the start of the injured employee’s blood-thinning regimen and review current injury status since blood thinners could interfere with the musculoskeletal treatment progress. Higdon’s efforts paid off, helping the employee return to full duty with restrictions and reducing the risk of another life-threatening embolism formation.
Telephonic Case Management
Janet Knorp, RN, BSN, CCM
A housekeeper with a rotator cuff injury had been stymied in her recovery. To help the employee progress, Janet Knorp was assigned to the case. Knorp quickly learned the woman had been noncompliant with her post-op physical therapy home exercise treatment due to her low tolerance for pain. In fact, the physician notes indicated doubts the injured employee “would ever progress due to her severe guarding of the shoulder.” Determined to help the injured employee meet her objectives, Knorp began an extensive educational program with the employee, explaining how the home exercises will prevent her from acquiring a worsening condition such as “frozen shoulder” which would further impact her ability to use her arm. She also explained that enduring a lower threshold of pain now by doing the exercises would help her overcome future pain and additional surgeries. Through Knorp’s coaching and persistent monitoring, the injured employee’s condition began to improve. She soon returned to full duty, resulting in 16 weeks of indemnity and a saving of nearly $16,000 on the claim.
Catastrophic Case Management
Sharon Murphy-Potts, RN, BSN, CRRN
A construction foreman for a pole building manufacturer fell 25 feet, sustaining a T-11 spinal cord injury resulting in paralysis below the waist. The man lived in an Amish community which maintained a simple lifestyle, with limited electricity at home and restricted use of modern technology. Aside from his job with the building company, he was married with four young children and maintained a family farm. An experienced case manager with an exceptional nursing background, Sharon Murphy-Potts used her extensive expertise and local connections to ensure the injured employee received the best treatment available along the rehab care path. She encouraged the inpatient rehab team and adjuster to approve an additional month stay, which allowed the injured employee to participate in an aggressive rehab plan, accessing rehab equipment not available at other facilities. This directly resulted in his ability to partially regain functional use of his legs. Adhering to the injured employee’s cultural tenets, Murphy-Potts researched and incorporated holistic and homeopathic supplements in medication management. She also spent many hours negotiating prices, providing equipment specifications, collaborating with the adjuster and rehab facility team to obtain adaptive vehicle equipment designed for farming. In addition, Murphy-Potts coordinated with a personal trainer to provide therapy services closer to the man’s home, which made it easier for his family and hastened recovery. Murphy-Potts also coordinated with an accessibility modification builder to make home adaptations to the employee’s home. Facilitating the needs of this employee not only helped restore his activities of daily living but also greatly improved his psychosocial wellbeing. This resulted in a positive discharge plan which enabled the injured employee to return home while preserving his quality of life, going back to work for the company in a desk-level role.
Disability Case Management
Kate Gilligan, BSN, RN, CCM
A 60-year-old male employee had sustained significant burns to his body following a house fire caused by a faulty kerosene heater. The employee was transferred in critical condition to the closest burn center where he was diagnosed with 3rd degree burns over 40 percent of his body as well as a grade 3 inhalation injury which eventually required a tracheostomy. Despite his critical condition, the employee was determined to return to work, expressing this desire as early as the initial assessment. He found the perfect case manager to meet this difficult challenge in Kate Gilligan, who worked closely with the employee’s wife and daughter to ensure the man’s benefits were initiated timely throughout this long recovery process. Gilligan also played an instrumental role in obtaining approval of three laser surgeries to treat hypertrophic scarring to improve the employee’s mobility. Gilligan was a constant presence in the employee’s recovery process, helping to manage care through lengthy stays at the burn center and inpatient rehab facility, followed by continued outpatient occupational therapy at a local rehab facility. The man’s determination was boosted by Gilligan’s efforts to facilitate appropriate work restrictions and use of pressure garments, allowing him to return to his previous position.
About Genex Services
Genex Services ( www.genexservices.com ), an Enlyte company, provides best-in-class clinical solutions that enable customers to transform their bottom lines while enhancing the lives of injured and disabled workers. Genex, a clinical management leader throughout North America, serves the top underwriters of workers' compensation, automobile, disability insurance, third-party administrators and a significant number of Fortune 500 employers. In addition, Genex clinical services are enhanced by intelligent systems and 360-degree data analysis. Its clinical expertise consistently drives superior results related to medical, wage loss, and productivity costs associated with claims in the workers' compensation, disability, automobile, and health care systems.
Enlyte ( www.enlyte.com ) is a family of businesses that include Mitchell, Genex and Coventry, leaders in cost-containment technology, independent medical exams (IME), provider and specialty networks, case management services, pharmacy benefit and disability management. The Enlyte businesses align their joint industry expertise and advanced technology solutions in a combined organization of nearly 6,000 associates committed to simplifying and optimizing property, casualty and disability claims processes and services.