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Telephonic Case Manager I - Charleston, WV
at Sedgwick CMS in West Virginia
Telephonic Case Manager I
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 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.
Supports the total performance management initiative.
QUALIFICATIONS
Education & Licensing
Baccalaureate degree in nursing (BSN) from an accredited college or university or equivalent work experience preferred. Active RN license required. Certification in case management, rehabilitation nursing or a related specialty is highly preferred.
Experience
At least one of the following is required:
A bachelors degree, or higher, in a health-related field and licensure as a health professional; or
Certification as a case manager; or
RN licensure and three (3) years clinical experience
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
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.
Sedgwick CMS is an Equal Opportunity Employer and a Drug-Free Workplace
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/15435480
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 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.
Supports the total performance management initiative.
QUALIFICATIONS
Education & Licensing
Baccalaureate degree in nursing (BSN) from an accredited college or university or equivalent work experience preferred. Active RN license required. Certification in case management, rehabilitation nursing or a related specialty is highly preferred.
Experience
At least one of the following is required:
A bachelors degree, or higher, in a health-related field and licensure as a health professional; or
Certification as a case manager; or
RN licensure and three (3) years clinical experience
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
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.
Sedgwick CMS is an Equal Opportunity Employer and a Drug-Free Workplace
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/15435480
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Published on Mar 11, 2010
Viewed: 312 times
Viewed: 312 times
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