Case Management Specialist
Job Title: Case Management Specialist
Position Type: Full Time
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 Claims Management Services, Inc. has a strong commitment to its colleagues and its clients. If you are seeking place where you can do great things for those whose lives you touch while maximizing your own career possibilities, Sedgwick CMS 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 theBest TPA in Americaand the covetedEmployer of Choicedesignation, 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; assessment of client's situation will include psychosocial needs, cultural implications and support systems in place.
- Creates a case management plan based on the assessment with measurable goals and objectives utilizing evidenced-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 outcomes 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.
- Performs other duties as assigned.
- Supports the organization's quality program(s).
Education & Licensing
Active RN license(s) required. Baccalaureate degree in nursing (BSN) from an accredited college or university or equivalent work experience preferred. Certification in case management, rehabilitation nursing or a related specialty is highly preferred.
Two (2) years of full-time equivalent of direct clinical care to the consumer required.
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 CMS is an Equal Opportunity Employer
Additional Information: CCM or CRRN highly preferred