Posted Date : October 12,2022
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : CASE-1134
Government Authority located in San Bernardino, California; USA based organization looking for expert vendor for worker compensation nurse case management services.
[A] Budget: Looking for Proposals
[B] Scope of Service:
(1) Vendor needs to provide worker compensation nurse case management services to the government authority located in San Bernardino, CA.
1. Telephone Nurse Case Management Services
- Proposer will provide a senior registered nurse (Telephonic Nurse) to perform telephonic interaction with the injured workers. For purposes of this agreement, a “senior registered nurse” is one who has worked as a registered nurse handling workers’ compensation claims for five years or more.
- The telephonic nurse will complete an initial phone call for individuals identified by the county, seeking to answer any questions and provide additional information to the injured workers.
- During the initial phone call, the telephonic nurse shall determine whether an injured worker should have a face-to-face interaction with a nurse and notify the proposer’s operation management, which will recommend the assignment of a field case manager.
- The telephonic nurse will report daily activities, if any, on each injured worker to the proposer’s operations management and the senior liaison manager on the activity performed so that a current status can be maintained on each claim.
2. Field Nurse Case Management Services
- The field nurses will be responsible for reporting the results of their services to proposer’s director of nursing and the senior liaison manager in a timely manner to ensure status reports are up to date. If there is a change in status on a claim that requires action, such as doctor visits, request for authorization (RFA), request delivery or applicant attorney involvement, such information must be immediately reported to the county risk management department workers’ compensation adjuster, proposer’s operations management, and the senior liaison manager.
3. Senior Liaison Manager
- Proposer shall appoint a senior liaison manager to provide record keeping, intervention, communication, and coordination to ensure the parties act in a timely manner to provide the services described herein to the injured workers. The senior liaison manager will record the developments and actions in each case referred to proposer and prepare any written documentation needed to immediately provide information requested by the county as to the status of any claim.
- The senior liaison manager will also be required to interact with and respond to the county risk management department claims staff, medical providers, the utilization review company, physicians identified by the county, and any injured worker regarding any issues.
- The senior liaison manager will be available to the county on a full-time equivalency basis but may be required to be accessible on a round-the-clock basis.
- The senior liaison manager will report to their operations management and provide weekly status updates, unless required more frequently by the county.
4. Communication
- Proposer’s staff will meet quarterly or bi-annually with the risk management department’s claims staff to identify and coordinate the need for cooperation and the provision of necessary information.
- Proposer’s staff will meet with the utilization review firm contracted by the county, and risk management department’s claims staff to coordinate and foster a more rapid turnaround for the RFAs and reports from treating or reviewing physicians
(2) All questions must be submitted no later than October 24, 2022.
[C] Eligibility:
- Onshore (USA Organization Only);
[D] Work Performance:
NA
Budget :
Deadline to Submit Proposals: November 18,2022
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : CASE-1134
Government Authority located in San Bernardino, California; USA based organization looking for expert vendor for worker compensation nurse case management services.
[A] Budget: Looking for Proposals
[B] Scope of Service:
(1) Vendor needs to provide worker compensation nurse case management services to the government authority located in San Bernardino, CA.
1. Telephone Nurse Case Management Services
- Proposer will provide a senior registered nurse (Telephonic Nurse) to perform telephonic interaction with the injured workers. For purposes of this agreement, a “senior registered nurse” is one who has worked as a registered nurse handling workers’ compensation claims for five years or more.
- The telephonic nurse will complete an initial phone call for individuals identified by the county, seeking to answer any questions and provide additional information to the injured workers.
- During the initial phone call, the telephonic nurse shall determine whether an injured worker should have a face-to-face interaction with a nurse and notify the proposer’s operation management, which will recommend the assignment of a field case manager.
- The telephonic nurse will report daily activities, if any, on each injured worker to the proposer’s operations management and the senior liaison manager on the activity performed so that a current status can be maintained on each claim.
2. Field Nurse Case Management Services
- The field nurses will be responsible for reporting the results of their services to proposer’s director of nursing and the senior liaison manager in a timely manner to ensure status reports are up to date. If there is a change in status on a claim that requires action, such as doctor visits, request for authorization (RFA), request delivery or applicant attorney involvement, such information must be immediately reported to the county risk management department workers’ compensation adjuster, proposer’s operations management, and the senior liaison manager.
3. Senior Liaison Manager
- Proposer shall appoint a senior liaison manager to provide record keeping, intervention, communication, and coordination to ensure the parties act in a timely manner to provide the services described herein to the injured workers. The senior liaison manager will record the developments and actions in each case referred to proposer and prepare any written documentation needed to immediately provide information requested by the county as to the status of any claim.
- The senior liaison manager will also be required to interact with and respond to the county risk management department claims staff, medical providers, the utilization review company, physicians identified by the county, and any injured worker regarding any issues.
- The senior liaison manager will be available to the county on a full-time equivalency basis but may be required to be accessible on a round-the-clock basis.
- The senior liaison manager will report to their operations management and provide weekly status updates, unless required more frequently by the county.
4. Communication
- Proposer’s staff will meet quarterly or bi-annually with the risk management department’s claims staff to identify and coordinate the need for cooperation and the provision of necessary information.
- Proposer’s staff will meet with the utilization review firm contracted by the county, and risk management department’s claims staff to coordinate and foster a more rapid turnaround for the RFAs and reports from treating or reviewing physicians
(2) All questions must be submitted no later than October 24, 2022.
[C] Eligibility:
- Onshore (USA Organization Only);
[D] Work Performance:
NA
Budget :
Deadline to Submit Proposals: November 18,2022
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$