Case Manager (Personne gestionnaire de cas)

Workplace Safety and Insurance Board (WSIB); Guelph; On-site; CAD 65,000 - 85,000; Full time

Job summary

A government agency in Ontario is seeking a Case Manager to oversee entitlement decisions and manage claims effectively. You will develop integrated case management plans and facilitate the return-to-work process while ensuring compliance with relevant policies. Ideal candidates possess a university degree and have experience in adjudication or case management. This role emphasizes proactive communication to support workers and employers in understanding their rights and obligations.

Benefits

Equity, diversity and inclusion commitment

Barrier-free and accessible employment practices

Qualifications

• Two years prior experience in Adjudication or Case Management.
• Experience in assessing, planning, and facilitating services.
• Ability to inform parties of their rights and obligations.

Responsibilities

• Make entitlement decisions based on legislation and communicate them.
• Develop, implement, and monitor case management plans.
• Facilitate return-to-work (RTW) processes and support workplace parties.

Skills

Adjudication

Customer Service

Proactive Case Management

Communication

Problem-Solving

Education

University completion at undergraduate level

Job description

Overview

Job Summary :

Responsible for the entitlement decision and overall management of claims through the development, implementation, communication and monitoring of comprehensive and integrated case management plans for all case activities.

Case Managers use a proactive case management approach to make and communicate decisions on benefits and services in a timely fashion that are consistent with relevant WSIB policy. Address worker and employer needs by actively listening, collecting, and providing relevant information, and helping the workplace parties understand their rights, responsibilities, and obligations.

Case Managers may be assigned to cases in the early phase of the case lifecycle or the later phase of the case lifecycle (including pre-1990 claims). Case Managers follow a structured case management framework, to enable them to achieve high quality entitlement decisions, return-to-work and recovery outcomes, and success with case planning and implementation.

Major Duties and Responsibilities

1. Make entitlement decisions based upon legislation, policy, and best practices and communicate these decisions verbally and in writing to applicable parties by :

• Proactively collecting information from workplace parties and healthcare providers required for eligibility decisions and responding to inquiries;
• Providing education on WSIB benefits, policies, and processes while informing parties of their rights and obligations under the Act, and of the consequences of non-compliance;
• Ensure appropriate earnings information is on file to determine the appropriate duration and level of benefits;
• Monitoring employer and worker compliance;
• Determining if a breach of obligations has occurred, levying penalties and fines, and adjusting benefits as appropriate; referring to and / or working collaboratively with internal resources for appropriate action, when required.

Develop, implement, and monitor comprehensive and integrated case management plans for all activity in the case required to achieve recovery, community integration, and where possible, return to work (RTW) by :

• Collecting information to progress the case; assessing and positioning each case along its appropriate recovery path; setting goals and making decisions based on legislation, policy, and best practices;
• Planning activities in collaboration with workplace parties and team members; participating in case conferences and team meetings with the service delivery team and management, and providing consultative advice (mentoring) to team members;
• Coordinating and taking action on planned activities; reviewing and monitoring new information as received; closing plan activities when active case management is no longer required; following up and evaluating close cases to ensure case management plan continues to be effective.

Provide targeted activities focused on identifying RTW factors, removing obstacles, and leveraging opportunities to facilitate a safe return to suitable work by :

• Coordinating and facilitating RTW cooperation between the workplace parties;
• Supporting workplace parties in their return-to-work efforts by sharing any available information about the workers’ capabilities and / or precautions;
• Arranging, assessing, and adjusting the delivery of return-to-work assessments and plans where needed;
• Promoting prevention, disability management, RTW, and related programs to workplace parties; sharing best practices; connecting workplace parties with expert resources when they would benefit from increased capability to prevent and / or manage injuries and illness;
• Keeping clients and employers informed of the status and progress of the case, ensuring they are fully engaged in removing barriers to, and planning RTW.

Identify and co-ordinate intervention by internal and external specialty resources and ensure timely and appropriate completion of these interventions and services by :

• Referring requests for health care entitlement to the appropriate resource and liaising as required;
• Referring requests for equipment, personal care allowance, home / vehicle modifications, and hobbies to Health Services and liaising as required.

Attempt to prevent or resolve disputes. Handle requests for reconsideration and, if appealed, arrange access, and process the objection.

Utilize knowledge of the case management framework and understanding of the application of WSIB policies and WSIB Acts to conduct case and telephone quality reviews.

Perform other related duties as assigned or required.

Qualifications

Job Requirements : Education

• University completion at undergraduate level.

Experience

• Two years prior experience in Adjudication or Case Management and Customer Service. Adjudication is a process of decision making, gathering an weighing information against guidelines, policy and laws to arrive at an objective outcome Case management is a process of assessment, planning, facilitation, and advocacy for options and services to meet an individual\'s needs to promote optimal outcomes. Key activities include : collecting information, making decisions, coordination and actioning activities; reviewing, monitoring, guiding and directing cases towards resolution.

This position is currently eligible for an education equivalency. Additional years of experience will be considered in place of levels of education on a 2 : 1 basis.For every level of education not completed, an additional 2 years of experience will be considered as equivalent, in addition to the minimum prior years of experience as set out in the job requirements. Management has set a minimum threshold for education equivalency at the College diploma program of overone year and up to two years level.

Education Levels

College diploma program of overone year and up to two years plus6 years of experience

There are no equivalencies for established professional certifications and / or designations.

Our commitment to equity, diversity and inclusion

We respect and value the diversity of our people. We strive to create an environment where employees can be themselves and where our differences are celebrated.

The WSIB is committed to being accessible and inclusive, and following barrier-free and accessible employment practices in compliance with the Accessibility for Ontarians with Disabilities Act (AODA). Should you require accommodation through any stage of the recruitment process, please let us know when we contact you and we will work with you to meet your needs.