Medical Case Manager

Gategroup; Mississauga; On-site; CAD 70,000 - 90,000; Full time

Job summary

A prominent company in the travel industry seeks a dedicated professional to manage medical absences and return-to-work plans. The role includes conducting medical investigations, liaising with employees and insurance providers, and ensuring compliance with treatment guidelines. Candidates should possess strong analytical and communication skills, along with a relevant degree in healthcare or human resources. This position offers an opportunity to contribute to a supportive work environment, focusing on optimizing employee well-being and organizational efficiency.

Qualifications

• Strong analytical skills with the ability to assess medical information.
• Experience in case management or similar roles is a plus.
• Ability to navigate complex HR issues effectively.

Responsibilities

• Manage medical absences and return to work plans.
• Conduct thorough investigations of medical absences.
• Collaborate with various stakeholders to ensure compliance with treatment guidelines.

Skills

Case management

Medical investigations

Effective communication

Attention to detail

Education

Relevant degree or certification in healthcare or human resources

Job description

We’re looking for motivated, engaged people to help make everyone’s journeys better.

Responsible for managing medical absences, return to work plans, conducting medical investigations and supporting the administration of Workers’ Compensation and short-term disability claims. Acts as liaison between employees, management, and insurance providers, to ensure workers receive the best care possible, while also protecting the interests of the company.

• Conduct comprehensive investigations of employee medical absences to verify circumstances, diagnosis, treatment, therapies and return to work assessments from medical providers.
• Performs strategic case management of medical absences including information from employee interviews, managers, treating providers, analysis of investigative findings, and management of appeals administration.
• Assess medical information provided by employee’s, physicians, claims managers and supportive treatment providers to determine medical accuracy of diagnosis, restrictions, limitations, recovery period, consistency with medical duration guidelines, and a return-to-work plan (RTW), or alternative outcomes.

• Ensures complete documentation of event and all subsequent treatment and therapeutic care, formulating medical report requests to all treatment providers involved, and alignment with medically supported recovery guidelines.
• Identification and escalation of medically complex absences and HR issues
• Support the completion and submission of WC forms, including Form 7s, Supplemental Reports, Intent to Object, etc., when requested.

• Creates and executes RTW plans based on all documentation and medical and therapeutic provider recommendations, review of standard forms and working conditions the employee is returning to.
• Manages the Absence Inbox and medical information received from employees
• Navigates meetings with employees, operations managers, and/or union representatives to address RTW, workplace accommodation concerns, and negotiates positive outcomes.
• Throughout investigations and case management, contacts providers, insurance carriers and investigators, maintains constant vigilance for red flags and escalates to leadership for review and development of a strategic plan to investigate further towards resolution.
• Maintains a constant review of processes and events and develops recommendations for cost containment and/or claim closure, as appropriate.
• Collaborates with staff on the team to prioritize cases and events, plan coverage for vacancies or extended leave.

If you want to be part of a team that helps make travel and culinarymemories, join us!