A Real Coal Miner's Daughter Continued:

It’s great that you’re able to keep the family history of working with mining alive. You started here in 2003, right? What's your current job title?
Yes. I started in August 2003 as a Case Manager, but I’m really more of a Nurse Coordinator.

Tell us about a typical day? What happens when you walk into the office every morning?
Well, since starting here, I really believe I have developed good relationships with many of the claimants. In most of the files, the indemnity is settled and their medicals remain open. I also have several black lung claims. When I first came here, it took a while to review the files and get comfortable with the different regulations in each state I cover. I have been able to develop solid working relationships with many of the doctors, nurses, claimants and our Managed Care associates. I review bills for appropriateness and the relationship to the injury. I ensure patients are receiving appropriate medications and that their treatment is directed and related only to what they were awarded or agreed to in their settlement.
On a day-to-day basis, I do lots of problem solving. I arrange for office visit referrals, diagnostics, physician reviews, independent medical evaluations and very often, testing to ensure claimants are adhering to their physician's treatment plan. In my daily responsibiliites case management and utilization review go hand in hand.

What's the strangest claim you've been asked about?
There haven't been any really strange issues except for the one patient who recently denied accessing the emergency room despite the fact his signature and demographic information for that DOS matches our file. He claims he is often impersonated and as it happens, there is more than one person in the area with the same name. Tune in later for the outcome...

What are the typical claims you review like?
Injury to the lower back, neck and knees are primarily what I see. Many of the files I manage have not fully recovered from the effects of their injuries or surgeries.

Where did you go to school?
I am a Grad of Purdue U. in 1983.

Where did you work before joining us?
I worked for HealthSouth for about 12 years.

What’s one of the things that you’ve learned from the job that’s helped you at home?
One of the unforeseen benefits of my everyday experience in working for American Mining is that I have been able to assist my husband as he tries to grow his new business- particularly as it relates to employer responsibilities when work injuries occur and the actions that need to be taken to ensure a quick return to work.

So, you've got a new grandchild. Are you having fun with that?
I have five grandchildren—the newest one, Julian, was born March 18th. Ages range from 6 to a few months old. My life would be complete if only they lived a little closer with my son in IN and daughter in TX. I am originally from PA and lived in Indiana until 1986 and moved to Charlotte, finally finding our way to Birmingham so it is no surprise we are separated due to our jobs. The last time we were all together was Christmas, but I do manage to see them every few months even if it is only for a day or so.