Case Manager
Workplace Safety and Insurance Board (WSIB)
Thunder Bay-Bilingual Fr & Eng, ON, CA
5d ago

Job Summary :

Responsible for the overall management of claims through development, implementation, and monitoring comprehensive and integrated case management plans for all case activities.

Case Managers will be assigned either Pre 1990 cases or the early phase of the case lifecycle or the later phase of the case lifecycle.

Case Managers follow a structured case management framework, to enable them to achieve high quality outcomes and success with case planning and implementation.

Major Duties & Responsibilities

1. Develop, implement, and monitor comprehensive and integrated case management plans for all activity in the case required to achieve recovery, community integration, and where possible, return to work (RTW) by :

  • Collecting information to progress the case; assessing and positioning each case along its appropriate recovery path; setting goals and making decisions based on legislation, policy, and best practices;
  • Planning activities in collaboration with workplace parties and team members; participating in case conferences with the service delivery team and management;
  • coordinating and taking action on planned activities; reviewing and monitoring new information as received; closing plan activities when active case management is no longer required;
  • following up and evaluating close cases to ensure case management plan continues to be effective;
  • 2. Provide targeted activities focused on identifying RTW factors, removing obstacles, and leveraging opportunities to facilitate a safe return to suitable work by :

  • Co-ordinating and facilitating RTW cooperation between the workplace parties;
  • Arranging, assessing, and adjusting the delivery of work reintegration services where needed;
  • Promoting prevention, disability management, RTW, and related programs to workplace parties; sharing best practices; connecting workplace parties with expert resources when they would benefit from increased capability to prevent and / or manage injuries and illness;
  • Keeping clients and employers informed of the status and progress of the case, ensuring they are fully engaged in removing barriers to, and planning RTW.
  • 3. Identify and co-ordinate intervention by internal and external specialty resources and ensure timely and appropriate completion of these interventions and services by :

  • Referring requests for health care entitlement to the Nurse Consultant and liaising as required;
  • Referring requests for equipment, personal care allowance, home / vehicle modifications, and hobbies to the Occupational Therapist and liaising as required;
  • Referring requests for major home modifications to the Independent Living Consultant and liaising as required.
  • 4. Make entitlement decisions based upon legislation, policy, and best practices and communicate these decisions verbally and in writing to applicable parties by :

  • Providing education on WSIB benefits, policies, and processes while informing parties of their rights and obligations under the Act, and of the consequences of non-compliance;
  • Responding to worker’s and employer’s request for clarification and / or reconsideration;
  • Monitoring employer and worker compliance;
  • Determining if a breach of obligations has occurred, levying penalties and fines and adjusting benefits as appropriate;
  • referring to and / or working collaboratively with Regulatory Services for appropriate action, when required.

    5. Attempt to prevent or resolve disputes. Handle requests for reconsideration and, if appealed, arrange access and process the objection.

    6. Under the guidance of the Manager, Program Quality, when temporarily assigned, utilize knowledge of the case management framework and understanding of the application of WSIB policies and WSIB Acts to conduct case and telephone quality reviews.

    7. Perform other related duties as assigned or required

    Education

  • University completion at undergraduate level.
  • Experience

  • Three years prior experience in Adjudication or Case Management and Customer Service. Adjudication is a process of decision making, gathering an weighing information against guidelines, policy and laws to arrive at an objective outcome Case management is a process of assessment, planning, facilitation, and advocacy for options and services to meet an individual's needs to promote optimal outcomes.
  • Key activities include : collecting information, making decisions, coordination and actioning activities; reviewing, monitoring, guiding and directing cases towards resolution.

    Our commitment to equity, diversity and inclusion

    We respect and value the diversity of our people. We strive to create an environment where employees can be themselves and where our differences are celebrated.

    The WSIB is committed to being accessible and inclusive, and following barrier-free and accessible employment practices in compliance with the Accessibility for Ontarians with Disabilities Act (AODA).

    Should you require accommodation through any stage of the recruitment process, please let us know when we contact you and we will work with you to meet your needs.

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