(Hybrid) Senior Case Manager - Medical Management

West Virginia University is currently accepting applications for a Hybrid Senior Case Manager – Medical Management

About the Opportunity

Reporting to the Assistant Director, Employee Relations/Medical Management, this position will administer and manage WVU medical leaves of absence and FMLA for all WVU employees to ensure the proper and consistent application of relevant policies/procedures and state/federal laws.

This position will monitor medical leaves to ensure that all procedural steps are followed in a timely manner. Obtains clarification after analyzing medical documentation and takes appropriate action in determination of employee’s eligibility for various medical leave programs.

The Senior Case Manager plays a critical role in comparing medical leaves to industry standard, managing to optimal case outcomes, and understanding comorbidities have on leave duration. They determine if independent consultation or medical evaluation is needed and collaborates with physicians or other third-party administrators on process and protocols.

At WVU, we strongly believe in work-life balance and keeping time for things we love outside our work. WVU offers generous benefits, including:

• 37.5-hour work week

• 13 paid holidays (staff holiday calendar)

• 24 annual leave (vacation) days per year

• 18 sick days per year

• WVU offers a range of health insurance and other benefits (this position is a benefits-eligible non-classified staff position)

• 401(a) retirement savings with 6% employee contribution match, eligibility to continue health insurance, and other retiree perks. Looking for more retirement benefits information? Check out retirement health insurance benefits, retirement income, and FAQ’s.

• Wellness programs

This position is hybrid, with the expectation of a schedule that includes onsite and work from home opportunity. This position is expected to work the hours needed to meet professional responsibilities.

What you'll do:

• Administer and manage WVU medical leaves of absence and Family and Medical Leave Act (FMLA) for all WVU employees including regional campuses and dual employees, to ensure the proper and consistent application of relevant University policies/procedures and state and federal law.

• Monitor medical leaves to make certain that all procedural steps are followed in a timely manner. Provide information in person, telephonically, or through written correspondence to employees/supervisors, EBOs and administrators regarding the requirements for and employee rights under the WVU medical leave policies, FMLA, catastrophic leave, and other applicable state and federal programs.

• Reviews and analyzes medical documentation utilizing a medical judgment and understanding of simple to complex illness or injuries.

• Obtains clarification and takes appropriate action including determination of employee’s eligibility for various leave programs such as authorized medical leaves, FMLA, catastrophic leave, and other applicable state and federal programs.

• Explains and distributes appropriate forms to employees for completion depending on the requested Medical Leave.

• Prepares and presents case status and problems for discussion at meetings with Assistant Director, Director, and General Counsel. If indicated, discuss case status with employee, treatment providers, third party administrator, and vocational rehabilitation Case Managers.

• Manages relationship and partnership with WVU Medicine in the administration of dual appointment employees on Medical Leave.

• Measures medical leaves and compares to industry standard, managing toward optimal case outcomes; understanding the impact that comorbidities have on leave duration.

• Determines if an independent consultation or independent medical evaluation is needed. If so, researches and recommends an independent medical provider and schedules employee for an appointment.

• Collaborates with physicians or other Third-Party Administrator to develop independent evaluation resources, process, and protocols.

• Educates employees and supervisors regarding leaves of absence policies under WVU policies and procedures and FMLA.

• Educates employees regarding appropriate services and benefits for which they may be entitled such as catastrophic leave, modified duty, workers’ compensation, short- and long-term disability, ADA, Retirement, and Faculty and Staff Assistance Program, and makes appropriate referral(s).

• Advises University employees, supervisors, and management regarding medical leave and disability issues. Provides information to supervisors and EBOs regarding employees’ medical leave status. Works with employees, supervisor, and various WVU departments including Employee Relations, Environmental Health and Safety, Benefits, General Counsel, and Faculty and Staff Assistance Program in order to resolve problematic issues.

• Maintains and analyzes statistics and generates reports on medical leaves of absence. Identify cases exceeding industry standard guidelines. Identify problems or concerns and make recommendations to resolve the issues.

• Assists with work site visits to evaluate specific job environments for modified duty program.

• Plans, develops, organizes, and presents training programs to WVU employees regarding Medical Management programs, policies, and sick leave issues, traveling to regional campuses.

• Collaborates with Assistant Director, Employee Relations and the Director, Employee Relations on senior level analyses, projects, and programs including research and development of new programs.

• Provides consultation, guidance, and training to university administrators, deans, directors, managers, and employees regarding HR policies, procedures, and programs.

• Demonstrate positive customer service and co-worker relationships.

• Other duties as assigned by Assistant Director, Employee Relations.

Education:

Bachelor’s degree in nursing or medically related field, or equivalent combination of nursing education and experience..

Experience:

5-7 years of medical experience, preferably in Nursing, Occupational Rehab or related field.

Minimum of 3 years of past medical experience required, such as nursing, PT, OT, etc.

Knowledge, Skills, and Abilities

• Requires excellent medical skills in, case management, employee health and teaching (patient teaching).

• Must be computer literate with demonstrated ability to provide excellent written and verbal communication.

• Requires expert level knowledge of benefit policies, theories, trends, and workplace issues.

• Demonstrated ability to research and analyze information to arrive at valid conclusions, recommendations, and plans of action.

• Demonstrated organizational skills, attention to detail, and ability to meet deadlines are essential.

• Strong customer service initiative and follow-up, as well as problem analysis and problem-solving skills are required.

• Ability to relate effectively to the most sensitive inquiries or complaints.

• Ability to develop long-term plans and programs and to evaluate work accomplishments.

• Ability to prepare and deliver professional level public presentations.

• Must have demonstrated ability to exercise considerable judgment and discretion in carrying out the duties of this position.

• Proven ability to adapt successfully to a changing environment and goals.

• Ability to maintain confidentiality, professionalism, tact, and composure at all times, including stressful or sensitive situations.

• Ability to organize resources and establish priorities.

• Incumbent must demonstrate commitment to work whatever hours are required to provide exemplary service.

• Knowledge of health care resources. Demonstrated knowledge of applicable OSHA regulations related to employee health issues normally acquired through previous employee health and clinical nursing experience. Knowledge of occupational health issues.

• Ability to travel to various locations within the WVU system, including regional campuses and satellite locations, is required.

Preferred Qualifications:

Rehabilitation experience preferred.

Previous experience with administrating FMLA and other Medical Leave programs strongly preferred.

Employee Health background preferred.

At West Virginia University, we leverage our talents and resources to create a better future for our state and the world. As West Virginia's land-grant university, WVU has three campuses that touch each corner of the state. The WVU System includes 518 buildings on 15,880 acres, Extension Service offices in all 55 counties, ten experimental farms and four forests.
From the groundbreaking R1 research of our flagship campus in Morgantown to the career-oriented programs of WVU Potomac State in Keyser to the technology-intensive programs at WVU Tech in Beckley — the contributions of WVU employees directly impact the 1.8 million people of West Virginia every day, no matter their role or position.

Service, curiosity, respect, accountability, and appreciation are the core values that unite Mountaineers, inspiring one another to work tirelessly and support others as they seek to reach new heights. After all, when you're a Mountaineer, impossible is just another mountain to climb.
Creating an inclusive, engaged, and dynamic learning environment is core to WVU’s academic mission. We welcome candidates who can contribute a range of ideas, approaches, and experiences.

West Virginia University is proud to be an Equal Opportunity employer and is the recipient of an NSF ADVANCE award for gender equity. The University values diversity among its faculty, staff, and students, and invites applications from all qualified applicants regardless of race, ethnicity, color, religion, gender identity, sexual orientation, age, nationality, genetics, disability, or Veteran status.