Health Care Management Specialist

There are nine steps for the HMCS to follow in the Recovery Support phase of JEIS.

1.

Recovery plan. Based on all the case file information gathered to date (i.e., Attending Physician’s Statement or other medical information), coordinate a recovery plan, which may include facilitating an appropriate treatment program in collaboration with the member and the member’s healthcare providers.

2.

Member discussion. Discuss the proposed plan with the member and, based on this conversation, either move forward to the next step or consider re-evaluation of the plan if the member expresses concerns.

3.

Support and assistance. Work closely with the member throughout their recovery process to provide support and assistance to ensure successful progression. Maintain a regular contact schedule and a positive relationship with the member to:

  • Ensure they are receiving timely and appropriate care to support their recovery.

  • Understand their expectations and timing regarding returning to work.

  • Determine if other resources or specific support are required to help the member address any medical or non-medical challenges for recovery.

4.

Intervention. Types of intervention that may be considered based on medical recommendations (examples):

  • Cognitive Behavioural Therapy

  • Expedited appointments for diagnostics or possible treatments such as MRI, CT scans and, specialist consults etc.

  • Active physiotherapy programs

  • Functional restoration or reactivation programs

  • Addictions/substance abuse treatment Work conditioning programs

5.

Reporting. Forwards copies of the service provider reports to the member’s treating physician. Discusses with the member the report recommendations and resulting recovery plan to ensure they feel well-supported and confident in the plans.

6.

Monitoring. Monitor the member’s progress throughout the process and continue to offer support and assistance.

7.

Adjustments. As the member progresses through the plan, if modifications are required, make the necessary alterations. All notes and call records are documented on the internal case management system. Calls are recorded for quality assurance.

8.

Additional information. If the member does not appear to be recovering as quickly or as expected; request supplemental information from the
treating physician. Use the additional information to better understand the situation and adjust the recovery plan accordingly.

9.

Regular updates. Regularly update the Committee through emails, conference calls and/or regular meetings. will be sure to notify the Committee when new information is submitted to a member’s file; or at a minimum, every four weeks. Remember confidential information is not shared with the Committee. Examples of information typically communicated are:

  • The date of the next expected medical update from the member.

  • The member’s current abilities, restrictions and return-to-work prognosis.