The City of Memphis contracts with a company to provide Nurse Case Management Services (NCMS) for employees injured on the job. The initial 3-year contract runs from 2013-2016 with options to renew for additional 1-2 year periods. The NCMS aims to liaise with medical providers, develop treatment plans, monitor care, ensure compliance, and facilitate safe returns to work. Key risks include inadequate staffing, non-compliant employees, incompetent providers, technology issues, and cash flow problems. The project governance involves the City of Memphis overseeing the contract while the company provides NCMS and a Third Party Administrator processes claims.

1. City of Memphis
Nurse Case Management
Services
Kate Kananura
PADM : 7603

2. Project charter
• The City of Memphis ( CMO) has more
than 9,000 employees
• CMO offers benefits to all employees
injured at work
• Contractor (herein “company”)
provides Nurse Case Management
Services (NCMS) for administration of
On-the-Job Injuries (OJI)

3. Project Charter
– Initial term of
the NCMS a
contract is
three years,
(2013 – 2016)
with a renewal
option of
additional two
or one year
periods
Resource Needs:
• A licensed certified Nurse
Case Manager
• A competent project team
• An automated reporting
system
• Efficient medical service
providers
•Adequate cash flow

4. Objectives
• Liaise with COM’s appointed medical
service providers
• Develop rehabilitation treatment plans
• Monitor out of network medical
treatment
• Ensure employee compliance with
treatment
• Formulate plans for safe return to
work
• Process all referred OJI cases

5. High Risk assessment
• Inadequate staffing/lack of relevant
expertise may result into administrative
errors and omissions
•Malfunction of the automated system
would limit information flow.
•Incompetent medical service providers/
ineffective treatment

6. Governance
•COM- accountable for contract
management
•“Company”- responsible for all NCMS
services
•Third Party Administrator (TPA)designated by the city to processes
qualified OJI claims.

7. Governance
• TPA to process internal quality
reviews, formal file reviews, and
customer service file reviews.
• Company to Identify
accomplishments, obstacles, futures
CM plans and projected costs
• Company to ensure provision of
monthly cost reports and transaction
reports to COM and TPA

9. Communications plan
•Initial stakeholders meeting to discuss
requirements and assign roles.
• Bi weekly project team meetings to
discuss accomplishments, challenges and
way forward.
• Create an online interactive forum such
as dashboard to share project status
reports
• Arrange impromptu meetings for
emergencies
•Contractor to communicate with TPA as
needed

10. Risk register
Type
Description
Possible
consequence
Human Risk
Negligent,
incompetent
company staff;
Omissions &
High
errors, delayed
claims
processing,
delayed reports
Monitor staff,
Provide
trainings,
Motivate staff
Non compliance
of injured COM
employees
Delayed medical Medium
attention &
delayed return
to work,
increased
claims
Delayed
High
treatment &
medical
records;
patient’s
worsened
health; delayed
claims
processing.
Increase site
visits,
counseling,
COM staff
training,
Incompetent/
service
providers.
Prioritization
of Risk
Response
strategies
Maintain a pool
of competent
network and
out- of -network
service
providers.

11. Risk register (continued)
Technology
Risk
Malfunction of
the automated
reporting
system.
No 24 hour
access to
electronic case
notes, delays
in case
processing
High
Create back up
files
Ensure
efficient
maintenance
of equipment
Financial
Risk
Cash flow
shortage
Delays or halt
in service
provision.
Low
Reschedule or
terminate
service as per
contract
Media Risk
Any project
scandal
reported in
the press
Loss of
confidentiality
of employee
information,
COM ‘s image
badly
tarnished.
Low
Ensure
efficient
services,
Address any
negative
issues
promptly.

12. Evaluation criteria
• Availability of 24 hour case management
services to COM employees
• Injured employees must be contacted within
one business day of case referral
• Subsequent services, claims reports and
claim reviews must be completed within
specified timelines of each case category
• Safe creation, maintenance, and transfers of
employee files and information
• Availability of an automated reporting system
• Cost and transaction reports submitted to TPA
monthly
• Six month’s employee surveys to determine
level of satisfaction with NCMS