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.
To ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for multiple business lines by managing and training multiple units of colleagues located in claims offices and on site at client locations; to provide expertise in client specific case management and utilization review requirements; and to ensure customer satisfaction through the provision of these services.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Manages overall clinical operations for more than 3 assigned teams/offices; develops and implements clinical objectives and initiatives.
Assists with implementation of new business plan with goals and objectives for assigned locations/offices; provides expert medical and product support to Sedgwick claims and clinical staff.
Promotes and adheres to all URAC standards and assures compliance to maintain successful URAC certification.
Identifies challenges and creates solution for recruitment, hiring, staffing, process management and training needs; plans for staffing needs, including succession, bench-strength and new business; and supervises, coordinates and reviews the work of assigned staff.
Assists in establishing policy and procedures to assure compliance to best practices, clinical management services standards, state regulations, and client service requirements.
Monitors management reports relating to the area/office performance.
Delivers corporate training for clinical staff in conjunction with Sedgwick University; provides direct oversight of clinical orientation program; and coordinates with Sedgwick University for certification of training materials.
Provides assistance to the Director Clinical Operations in making budget recommendations; managing budget to ensure achievement of unit financial goals; ensures effective deployment of strategic project plans.
Identifies potential new product opportunities, processes and protocols; participates in presentations to clients, prospects and colleagues.
Supports and interfaces with account management; provides expertise in client specific case management and utilization review requirements; and develops and maintains positive productive relationships.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.
Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions.
Provides support, guidance, leadership and motivation to promote maximum performance.
Education & Licensing
For Managed Care: Current unrestricted RN license in a state or territory of the United States required. Bachelor's degree in nursing (BSN) from and accredited college or university or equivalent work experience preferred.
For Disability: Current unrestricted RN license in a state or territory of the United States required or Certified Rehabilitation Counselor (CRC) or Licensed Clinical Social Worker (LCSW) required in lieu of a Bachelor's degree in nursing (BSN) from an accredited college or university or equivalent work experience.
Ten (10) years of related experience or equivalent combination of education and experience required to include five (5) years medical case management, five (5) years clinical and two (2) years supervisory experience. Workers' compensation or disability experience preferred.
Skills & Knowledge
Knowledge of multiple business line medical case management environments
Knowledge of resources available regarding the regulations and parameters of third party reimbursement
Knowledge of statutory requirements of state's jurisdiction as appropriate to job
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.
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
Computer keyboarding, travel as required
Hearing, vision and talking
Credit security clearance, confirmed via a background credit check, is required for this position.
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.