Workers Compensation Medical Management

The City is looking for Workers Compensation Medical Management Provider to provide 1) Workers Compensation Utilization Review services ; 2) Workers Compensation Medical Case Management services; and 3) Workers Compensation Agreed Medical Provider List Management for the City's Alternative Dispute Resolution (ADR) Program. Utilization Review: Provide prospective (pre-certification), concurrent and retrospective utilization review services to determine whether aspects of a patient’s medical care and requested medical treatment and/or services is medically necessary and appropriately delivered for the City's Workers Compensation Program. Medical/Nurse Case Management: Provide telephonic and field Nurse Case Management services at the direction of the Third-Party Administrator, following the City's Medical Case Management protocols. ADR Medical Provider List Management: Maintain and publish the City's Workers Compensation ADR Medical Provider List. This will include verifying providers on the list continue to accept Workers Compensation and updating the list when new providers are added or removed. The City's ADR Medical Provider List is a joint approved, between the bargaining unit(s) and the City, of medical providers who will evaluate, treat and report on City employees within the ADR program; and medical/legal providers who will evaluate and report on City employees within the ADR program. Provider may submit proposals on any of the 3 services noted above or all of the above services. The City reserves the right to select one or more providers to meet each of these service needs.