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Clinical Consultation RN
at Sedgwick CMS in Utah
Clinical Consultation RN
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and "Claim Your Future."
PRIMARY PURPOSE:
To triage calls from clients; to assess needs, giving appropriate care advice and disposition to appropriate level of care treatment facility; to promote quality cost-effective outcomes through communication and available resources; and to provide quality, cost effective alternatives to emergency or acute care.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Applies all phases of the nursing process; i.e. assessment, planning, implementation and evaluation when triaging calls.
Identifies the needs of caller by triaging, obtaining general health information and/or physician services referral.
Evaluates need for alternative treatment through telephonic contact and assessment with service provider.
Triages patient utilizing computerized protocols/algorithms; interviews patient to obtain pertinent data; and enters data into computer system.
Identifies life-threatening emergencies and recommends appropriate interventions.
Refers issues requiring physician interventions to physician in a timely manner; directs patients to appropriate level of care including but not limited to the nearest emergency room, urgent care facility, primary treating physician or home care.
Demonstrates effective verbal communications; communicates phone advice in a calm manner ensuring it is properly received and understood.
Adheres to quality assurance standards.
Interacts and coordinates work of Physician Advisors as necessary.
Serves as resource to triage team members.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the total performance management initiative.
QUALIFICATIONS
Education & Licensing
BS/BA degree in nursing preferred. Active unrestricted RN license issued in United States required.
Experience
Three (3) years recent clinical practice experience required.
Skills & Knowledge
Strong knowledge of nursing practice and theory
Knowledge of the insurance industry and claims processing
Knowledge of current alternative resources and treatments in out-patient and alternative care settings.
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
WORK ENVIRONMENT
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.
NOTE:
Credit security clearance, confirmed via a background credit check, is required for this position.
Sedgwick CMS is an Equal Opportunity Employer
and a
Drug-Free Workplace
REQUIREMENTS:
Multilicensure preferred
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://sedgwickcms.contacthr.com/16862983
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and "Claim Your Future."
PRIMARY PURPOSE:
To triage calls from clients; to assess needs, giving appropriate care advice and disposition to appropriate level of care treatment facility; to promote quality cost-effective outcomes through communication and available resources; and to provide quality, cost effective alternatives to emergency or acute care.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Applies all phases of the nursing process; i.e. assessment, planning, implementation and evaluation when triaging calls.
Identifies the needs of caller by triaging, obtaining general health information and/or physician services referral.
Evaluates need for alternative treatment through telephonic contact and assessment with service provider.
Triages patient utilizing computerized protocols/algorithms; interviews patient to obtain pertinent data; and enters data into computer system.
Identifies life-threatening emergencies and recommends appropriate interventions.
Refers issues requiring physician interventions to physician in a timely manner; directs patients to appropriate level of care including but not limited to the nearest emergency room, urgent care facility, primary treating physician or home care.
Demonstrates effective verbal communications; communicates phone advice in a calm manner ensuring it is properly received and understood.
Adheres to quality assurance standards.
Interacts and coordinates work of Physician Advisors as necessary.
Serves as resource to triage team members.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the total performance management initiative.
QUALIFICATIONS
Education & Licensing
BS/BA degree in nursing preferred. Active unrestricted RN license issued in United States required.
Experience
Three (3) years recent clinical practice experience required.
Skills & Knowledge
Strong knowledge of nursing practice and theory
Knowledge of the insurance industry and claims processing
Knowledge of current alternative resources and treatments in out-patient and alternative care settings.
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
WORK ENVIRONMENT
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.
NOTE:
Credit security clearance, confirmed via a background credit check, is required for this position.
Sedgwick CMS is an Equal Opportunity Employer
and a
Drug-Free Workplace
REQUIREMENTS:
Multilicensure preferred
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://sedgwickcms.contacthr.com/16862983
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Published on Aug 18, 2010
Viewed: 286 times
Viewed: 286 times
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