Case Management Specialist
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Providing both satisfying and challenging work along with a highly professional and friendly work atmosphere, Sedgwick has a strong commitment to its colleagues and its clients. If you are seeking a place where you can do great things for those whose lives you touch while maximizing your own career possibilities, Sedgwick is the place for you. As the largest and most innovative Third Party Administrator in the claims industry and the first and only TPA to receive both recognition as the Best TPA in America and the coveted Employer of Choice designation, we invite you to come be a part of our team and, "Claim Your Future."
PRIMARY PURPOSE: To perform initial and ongoing clinical assessment and evaluate need for alternative treatment, to negotiate and coordinate appropriate medical treatment and length of disability with providers and employers; and to implement a case management plan with ongoing monitoring to ensure quality and appropriate service delivery of the case management process.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Performs initial and ongoing clinical assessment via telephone calls to client (injured employee), employer, physician and attorney as indicated; assesses client's situation for psychosocial needs, cultural implications and support systems in place.
- Creates a case management plan based on the assessment with measurable goals and objectives utilizing evidence-based criteria; monitors ongoing progress toward these goals and objectives; implements plan through case management interventions and communication with all parties to reach desired goals and objectives.
- Evaluates need for alternative treatment.
- Negotiates appropriate level and intensity of care and disability duration with providers through use of medical and disability duration guidelines, adhering to quality assurance standards,
- Negotiates and coordinates a prompt return to work with employer.
- Measures interventions to determine the outcome of the case manager's involvement to include clinical, financial, variance, quality of life, and client satisfaction; maintains accurate record of management including costs, savings and demographic data.
- Provides case direction and supervision to field case specialists when on-site intervention is required; ensures quality and appropriate service delivery.
- Communicates effectively with handling claims examiner, client, claimant, attorney and supervisor.
- Maintains client's privacy and confidentiality, promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the organization's quality program(s).
Education & Licensing
Current unrestricted RN license(s) in a state or territory of the United States required. Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred. Certification in case management, rehabilitation nursing or a related specialty is highly preferred.
Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years of fulltime equivalent providing direct clinical care to the consumer required or equivalent combination of experience and education.
Skills & Knowledge
- Knowledge of workers' compensation laws and regulations
- Excellent oral and written communication, including presentation skills
- PC literate, including Microsoft Office products
- Leadership/management/motivational skills
- Analytical and interpretive skills
- Strong organizational skills
- Excellent interpersonal skills
- Excellent negotiation skills
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer