Workers Compensation Medical Management

The City of Pasadena is seeking a Workers Compensation Medical Management Provider through solicitation number 2024-RFP-0652, with responses due by December 5, 2024. The contract aims to secure services in three key areas: Workers Compensation Utilization Review, Medical Case Management, and Management of the City's ADR Medical Provider List. The Utilization Review component involves assessing the medical necessity and appropriateness of treatments through prospective, concurrent, and retrospective reviews to ensure optimal care for injured employees under the City's Workers Compensation Program. Medical Case Management services will be delivered via telephonic and field nurse case management, following the protocols established by the Third-Party Administrator, to coordinate and oversee medical treatment for injured workers. Additionally, the provider will be responsible for maintaining and updating the City's ADR Medical Provider List, which includes verifying provider acceptance of Workers Compensation and ensuring the list reflects current providers authorized to evaluate, treat, and report on City employees within the ADR program. Proposals can be submitted for any combination of these services or all three, with the City reserving the right to select one or multiple providers to fulfill each service area. The contract size is estimated between $500,000 and $2,000,000, and the project is managed by the Pasadena City Managers Office in California. Interested providers can contact Matthew Howard via email or phone for further information, and additional details are available through the City’s procurement portal.