MB-10427 - USA (New Jersey) - Worker’s Compensation Claims Managed Care Service - Deadline September 24,2026

(1) Vendor needs to provide worker’s compensation claims managed care service. – Provide managed care for worker’s compensation claims. – Provide the agency with the managed care of worker’s compensation claims relating to:• Network access:– Utilization review.– First report of Injury.– Re–pricing audit of provider bills.– 24–hour service access.• Telephonic case management:– Immediate activation of case management.– Physician referral within 24 hours.– Case management triage including employer, employee, and physician contact.– Initiation of quality assurance programs.– Establishment of optimize computer file.– Continuous updating of computer file.– Physician treatment plan.– Pre–authorization of all therapies, diagnostics, etc.– Case conferencing.– Multiple physician and therapy visits are set up on a priority basis.– Return to work program initiated from the onset.– Close monitoring of treatment by the case manager until maximum medical benefit is reached.– Continuous contact with the employer, physicians, patient, and all other related parties.– Ongoing utilization review and quality assurance.• On–site rehabilitation case services: Catastrophic injury or indemnity assessment• Pharmacy services as needed.(2) The contract period will be for one year.