Job Order Detail

Description

Employer Job Number: GO-00575869
Facility: 3sHealth
Job Description: The Employee Benefits team, in collaboration with health system partners, is embarking on a 3-year strategic plan to re-design the disability claims management model. This plan includes reframing claims management from adjudication to an active case management approach. This change positions the Claims Services area to provide improved service and collaborative support with plan members on their path to health.

We are seeking two Mental Health Advisors to partner with Claims Adjudicators in building a holistic rehabilitation strategy for plan members on a disability claim where mental health or addiction issues present as the primary medical condition or as secondary/complicating factor. As a subject matter expert in mental health and as a member of the Claims Services team, the Advisor will play an integral role in the case management process by:

analyzing plan member files including medical reports to support claims decision-making, determining the level of functionality and developing results focused, cost effective individualized rehabilitation plans to address claimant needs and facilitate early and sustainable return to work;

developing, implementing and monitoring  the progress of rehabilitation plans;

working with external providers and consultants to execute the rehabilitation plan, negotiating terms and conditions, overseeing their work and ensuring adherence to established standards of quality;

addressing expectations of all stakeholders through regular, active contact and continuous relationship building activities;

consulting regularly with the Adjudicator to facilitate the smooth flow of information, and collaborating on required changes to the case management plan;

providing training, coaching and mentoring to Claims Adjudicators to effectively ma
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