Case Management Specialist
IF YOU CARE, THERE'S A PLACE FOR YOU HERE
For a career path that is both challenging and rewarding, join Sedgwick's talented team of 21,000 colleagues around the globe. Sedgwick is a leading provider of technology-enabled risk, benefits and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. Whether they have a workplace injury, suffer property or financial loss or damage from a natural or manmade disaster, are involved in an auto or other type of accident, or need time away from work for the birth of a child or another medical situation, we are here to provide compassionate care and expert guidance. Our clients depend on our talented colleagues to take care of their most valuable assets -- their employees, their customers and their property. At Sedgwick, caring counts. Join our team of creative and caring people of all backgrounds, and help us make a difference in the lives of others.
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
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
Sedgwick Claims Management Services, Inc.