Short-Term Disability Specialist
If you are a skilled disability case management professional who has a passion for assisting individuals who are ill or injured regain their health, then this could be the job for you!
Beginning January 2021, ASEBP is implementing a new Short-Term Disability Management (STDM) pilot program, providing third-party management of covered members’ (CM) sick leaves, homing in on increased assistance throughout a CMs short-term leave in pursuit of successful case outcomes. That’s where the short-term disability management (STDM) coordinator comes in!
The Short-Term Disability (STDM) specialist will support the STDM pilot program by providing decision making and case management services, including medical management, for CMs with sick leave absences greater than two weeks (14 calendar days) and up to 90 days in duration. This role will provide coordination of medical assessments; requests for medical information; expedited treatment; and coordination and funding of treatments. The STDM specialist will plan, coordinate and monitor the return to work and/or transition to other leave types (eg. extended disability, personal leave). This position will also consult and collaborate with participating employer groups (EGs) to support successful case outcomes.
Your Key Responsibilities
- Assess STDM applications for eligibility to STDM and communicate if sick leave absence is medically necessary or not to the CM and EG.
- Apply a “whole person” approach to the adjudication process, considering individual needs of the CM and the EG.
- Effectively communicate and manage the results of difficult or adverse decisions with respect to individuals not qualifying for STDM and reactions from clients and stakeholders (employer, union, health care providers), including appropriate documentation of said decision in FINEOS.
- Medical management of the STDM claims, including identifying the need for and coordination of medical assessments, requests for medical information, expedited treatment, and coordination and funding of treatments.
- Work collaboratively with EG to plan the return to work (RTW), including proposing a gradual RTW plan or full RTW plan, monitoring success of the RTW plan, and making adjustments as needed.
- Identify trends that indicate a root cause of health issues for a specific EG or for particular positions; liaise with appropriate internal resources to address such issues.
- Manage CM’s expectations with respect to the STDM program, roles and responsibilities, and integration with EDB and other benefits.
- Respond to all inquiries from CMs, their representatives, and ASEBP staff in accordance with service standards.
- Collaborate with and respond to inquiries from EGs to achieve successful resolution of STDM claim.
- Research and maintain knowledge of community services and available resources.
- Document and prepare confidential information, reports, letters, and case notes.
- Follow up with CMs, as appropriate, to assess their perception of health and functioning and to discuss information obtained through medical reporting/assessments, with a goal of fostering shared understanding of progress and next steps.
- Appropriate use of discretionary spending including invoice processing.
- Travel to conduct face-to-face meetings with CMs, EGs, client representatives and health care providers on a regular basis to foster relationships and facilitate return to pre-illness/injury full time equivalent, as required.
- Attend and actively participate in team meetings, training, and activities.
- Alert the Early Intervention Services supervisor/manager and appropriate ASEBP staff of issues and trends identified through the role and interactions with CM’s and stakeholders.
- Ad hoc involvement in various working groups, projects, and/or organizational committees at both a team and organizational level.
- Work collaboratively with internal stakeholders across the organization.
- Ad hoc participation in external information sessions and meetings as needed.
- Provide support, assistance, and absence coverage for co-workers on an as needed basis.
- Assist with new employee orientation, including providing mentorship and training.
Your Education and Experience
- Minimum of three years’ experience in adjudication and case management of short-term disability claims.
- Completion of a two to three year technical or community college certificate or diploma in disability case management or other health-related fields.
A combination of education and experience may be considered.
- Ability to objectively analyze medical information (at times complex in nature) and use judgement and decision making to determine when to obtain clarification or additional details to assist in case management.
- Ability to assess style and level of readiness of client, including the ability to assess personal circumstances and situations.
- Exceptional communication skills, particularly when explaining complex information and/or delivering challenging or potentially contentious information (i.e. declination decision).
- Exceptional organizational, priority setting and time management skills.
- Strong computer skills, including Microsoft programs (e.g. Outlook, Word and Excel), Adobe and case management programs to document case activities and manage priorities and claims.
- Demonstrated ability to work independently as well as collaboratively within a team environment.
How To Apply
If you have the required qualifications and would like to become a member of our team, please submit your resume by Friday, October 23, 2020.
No phone calls please. We thank all interested individuals, but only those candidates being considered for an interview will be contacted. ASEBP is an equal opportunity employer.
All offers of employment for this position are conditional upon satisfactory background and reference checks, which may include a criminal record check, and/or education and employment verification.