Summary Description:

Workers' Compensation & Return to Work (RTW) Case Manager will manage workers' compensation claims across all Baystate Health entities. This role will orchestrate the full claim process from claim initiation to resolution in compliance with the Commonwealth of Massachusetts statutes while providing crucial support to injured workers on their journey to recovery. Additionally, the case manager will perform work in the administration of the self-funded plan; including annual assessments and renewals for the Department of Industrial Accidents, data requests for excess workers’ compensation plan and Baystate Health Insurance Captive as needed.

This role will also manage all activities associated with returning an injured employee to work in coordination with the RTW team which includes the Baystate Health (BH) injured employee, Employee Health Services and medical providers, managers/supervisors, ADA Case Manager, Safety, and Human Resource areas. This is accomplished with the following: 1) developing a systems approach to care delivery for a given patient population (injured employees) across the care continuum; 2) assume case management role with implementing initiatives that improve quality, efficiency, and injury care cost; 3) demonstrate compassion, inclusiveness, and raising the standard of excellence to achieve maximum value and outcomes. 4) have regular meeting with Department managers to promote the Modified Duty Program. Reports to Leave and Accommodations Manager.  

Position is required to work periodically onsite for management and employee meetings; development of RTW plans and development of modified duty opportunities.    

Job Requirements:

1) Coordinate and implement case management and review of workers' compensation cases in conjunction with the third-party administrator. Analyzes and resolves questions dealing with a workers' compensation injury or occupational disease; acts as liaison with the third party administrator and interpret and clarify complex statutes and regulations in regard to workers' compensation

2) Manage workers' compensation claims from start to finish, including reporting, investigating, and tracking claims. Serve as the main point of contact for employees regarding workers' compensation issues, providing guidance and support throughout the claims process.

3) Support and participate in claim reviews and litigation discussions with third party administrator and defense counsel. Track all settlement cases and ensure appropriate documentation/HR system updates.

4) Collaborate with Employee Health Services, Leave & Accommodation team, HR, supervisors, and injured employees to ensure accurate and timely reporting of all workplace injuries and illnesses. Liaise with insurance providers, legal professionals, and healthcare providers to facilitate the timely processing of claims and effective communication between all parties involved.

5) Assist department manager in the administration of self-insured and fully-insured workers’ compensation plans as well as excess workers’ compensation plan. Assist with annual renewals, annual applications and payroll audits for various plans with the collection and remittance of loss runs, salary exposures by WC classifications, federal 941 tax forms, employee census and payroll reports.

6) Review referrals and existing WC claims to identify any potential modified duty opportunities and provide services in a timely manner. Obtain functional capacity details, i.e., restrictions and limitations and the time period for which limitations are effective. Identify appropriate light duty or modified duty opportunities to support employees RTW strategy. Manage the process of transitioning by ensuring that employees returning to work after an injury can re-acclimate to their working environment, duties and responsibilities in the most efficient and effective way possible. May visit worksites of employees on modified duty to ensure a good match for managers and the employees on modified duty.

7) Promote and manage the Return to work Program, facilitate meetings with departments, and influence managers to accept restrictions in current and non-essential roles to facilitate work hardening for employees in the Return to Work Program. Manage the tracking of lost time and modified duty days for accuracy in obtaining meaningful data for BH program effectiveness and budgeting.

8) Support administration of ADA program through collaboration with ADA Case Manager, assisting with intake and transition from PML and FMLA to ADA protection and communications during intake process.

Minimally Required Expereince:

• Demonstrated knowledge of workers' compensation claim management laws, medical and legal terminology.

• 5 years work experience in three or more of the following: Workers' Compensation underwriting and claim administration (including working with legal professional, TPAs, insurance providers); Risk Management; occupational/employee health; performing ergonomic evalutions; nursing administration or Environmental safety role

Preferred Expereince:

• Certification in workers' compensation administration

• prior workers' compensation claims experience at healthcare organization

Skills/Competencies:

• Problem-solving and decision-making skills to assess and determine the validity of workers' compensation claims.

• Strong interpersonal skills with the ability to empathize and provide support to injured employees while handling stressful situations with profesionalism.

• Ability to create collaborative and respectful relationships with all key stakeholders to facilitate claims momentum.

-Strong knowledge of ADA/EEOC laws

-Excellent computer skills, including MS Office, Workday or other HR system Administration

-Proven proficiency in compiling, organizing, analyzing, and reporting data, using common data analysis tools such as Excel Data

-Excellent written and verbal communication skills

-Excellent interpersonal skills – demonstrated ability to build productive partnerships with internal and external constituents; especially with employees during difficult situations

-Demonstrated strong, influential, leadership and analytical and problem solving skills

-Strong sense of urgency and confidentiality

You Belong At Baystate

At Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. It makes us not just an organization, but also a community where you belong. It is how we advance the care and enhance the lives of all people.

DIVERSE TEAMS. DIVERSE PATIENTS. DIVERSE LOCATIONS.

Education:

Bachelor of Science (Required)

Certifications:

Equal Employment Opportunity Employer

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.

Ab out Baystate Health

Baystate Health (BH) is one of New England’s leading and largest integrated health care organizations, serving a population of nearly one million people throughout western New England. With roots dating back to the founding of Springfield City Hospital in 1873, Baystate Health has been providing high-quality and compassionate health care in western Massachusetts for more than 145 years. With more than 12,000 employees, a medical staff of nearly 3,100 physicians, and a net patient service revenue of more than $1.4 billion, the ever-growing health system includes five Massachusetts hospitals and the Baystate Mary Lane Outpatient Center in Ware:

• Baystate Medical Center in Springfield

• Baystate Children’s Hospital (located at Baystate Medical Center)

• Baystate Franklin Medical Center in Greenfield

• Baystate Wing Hospital in Palmer

• Baystate Noble Hospital in Westfield