Medical Case Manager

gategroup - Operational; Mississauga; On-site; CAD 60,000 - 80,000; Full time

Job summary

A leading operational management firm located in Mississauga, Canada, is seeking a dedicated individual to manage medical absences and coordinate return-to-work plans. In this role, you will act as a liaison between employees, management, and insurance providers to ensure a smooth process for those recovering. Candidates should have experience in case management and a strong understanding of Workers’ Compensation. Join us to make travel and culinary experiences better.

Qualifications

• Experience in managing medical absences and return-to-work plans.
• Strong understanding of Workers’ Compensation and disability claims.
• Ability to liaise with employees, management, and insurance providers.

Responsibilities

• Conduct investigations of employee medical absences.
• Perform strategic case management of medical absences.
• Create and execute return-to-work plans based on documentation.

Skills

Case management

Medical evaluations

Communication skills

Analytical thinking

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!