Medical Case Manager

Job Description Summary

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.

Annual Hiring Range:

CAD 75,000.00-CAD 90,000.00

Essential Duties and Responsibilities:

• 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 employees, 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.

Education:

• Associate or bachelor’s degree in a nursing or physical therapy field

Work Experience:

• At least three (3) years of progressively responsible professional experience in Workers’ Compensation, Short-Term Disability or Long-term Disability claims and case management, with at least three (3) of those years including complex case management, investigation, and collaboration with Legal counsel on recommendations and resolutions.
• Experience working with diverse populations
• Experience working in high stress, time sensitive environments

Job Skills:

• Medical certification, license or registration in good standing with the governing body of the field of study and practice
• Strong medical and appeal claims management skills
• Solid decision-making and creative problem-solving skills
• Ability to work calmly with individuals in highly emotional states
• Strong interpersonal skills and ability to work in a team
• Self-starter requiring little supervision

Communication Skills:

Must have excellent written and oral communication skills.

Core Competencies Required:

• Strong analytical, organizational, and investigative skills
• Strong business and financial acumen to support program strategy and efficiencies
• Strong verbal and written skills
• Flexibility and responsiveness
• Good follow-through and sense of accountability
• Detail oriented
• Solid computer skills, including advanced MS Office knowledge and ability to learn claims management program
• OSHA 10 hours certification a plus

Organization Structure

Direct Line Manager (Title): Food Manager, Operations

Demonstrated Competencies to be Successful in the Position:

• Thinking - Information search and analysis, problem resolution skills
• Engaging - understanding others, team leadership, developing people
• Inspiring - influencing and building relationships, motivating and inspiring, communicating effectively
• Achieving - delivering business results under pressure, championing performance improvement, customer focus

The above statements are intended to describe the general nature and level of work being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. Management reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

Candidates will be required to go through a criminal background check.

gategroup is an equal opportunity employer committed to workforce diversity. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or other ground under applicable law.

Gate Gourmet Canada Inc. is pleased to accommodate applicants who have a disability up to the point of undue hardship during the recruitment, assessment and selection process. Please inform our Recruitment Team if you require a disability-related accommodation to participate in the recruitment process.