Medical Case Manager

• 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.

Gategroup